Provider File Specialist II

Summary

Responsible for the maintenance of all provider files through assignment and enrollment on specified provider systems/databases. Responsible for running various queries for reporting on corporate, division, and department levels.

Description

What You’ll Do:

• Obtains necessary information (written notifications, faxes, emails, or telephone contacts) and establishes certification of healthcare service providers.
• Prepares provider files/maintains provider data (updates, additions, deletions) on the provider information management system (PIMS)or appropriate provider systems/database.
• Generates and analyzes various provider reports to management.
• Assists with providing technical support through system testing to ensure system enhancements/modifications.
• Researches/resolves issues/problems from providers related to eligibility, recertifications, edits, billing, etc.
• Contributes to department's production standard by working on PIMS and AMMS (automated medical management systems) or appropriate provider system/database maintenance/error reports.
• Contributes to and participates on special projects, which may include but are not limited to the following: mass rate updates, quality improvement, audits, etc.
• Work environment: Typical office environment. May involve travel between office buildings.
  
  

To Qualify For This Position, You’ll Need

• High School Diploma or equivalent.
• Three (3) years of experience in customer service, claims processing, and/or provider network certification, or combination.
• Working knowledge of word processing, spreadsheet, and database software.
• Knowledge/understanding of PIMS and AMMS.
• In-depth knowledge of provider certification process, claims processing operations/systems.
• In-depth knowledge of pricing methodology and discount programs.
• Good judgment skills.
• Demonstrated verbal and written communication skills.
• Demonstrated proficiency in spelling, punctuation, and grammar skills.
• Basic business math proficiency and knowledge of mathematical or statistical concepts.
• Analytical or critical thinking skills.
• Ability to handle confidential or sensitive information with discretion.
• Working knowledge of DB2 or other database software.
• Microsoft Office.
  
  

What Blue Can Do For You

Our comprehensive benefits package includes:

• 401(k) retirement savings plan with company match
• Subsidized health plans and free vision coverage
• Life insurance
• Paid annual leave — the longer you work here, the more you earn
• Nine paid holidays
• On-site cafeterias and fitness centers in major locations
• Wellness programs and a healthy lifestyle premium discount
• Tuition assistance
• Service recognition
  
  

What To Expect Next

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Management will be conducting interviews with those candidates who qualify, with prioritization given to those candidates who demonstrate the preferred qualifications.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.

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Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains Affirmative Action programs to promote employment opportunities for minorities, females, disabled individuals and veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities.

If you need special assistance or an accommodation while seeking employment, please e-mail [email protected] or call 1-800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.