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.

Palmetto GBA, – one of Blue Cross Blue Shield's South Carolina subsidiary companies.

This position is full-time (40-hours/week) Monday-Friday in a typical office environment. You will work an 8-hour shift scheduled during our normal business hours of 8:00AM-5:00PM. It may be necessary, given the business need to work occasional overtime. You may be required to travel between buildings. This role is located at 17 Technology Circle, Columbia, SC, 29203.

This position requires the ability to obtain a security clearance, which requires applicants to be a U.S. Citizen.

Blue Cross Blue Shield of South Carolina and its subsidiary companies have contracts with the federal government subject to the Service Contract Act (SCA). As a Service Contract Act (SCA) employee, you are required to enroll in our health insurance, even if you already have other health insurance. Until your enrollment is complete, you will receive supplemental pay for health coverage.

Your coverage begins on the first day of the month following 28 days of full-time employment.

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.

Required

Education:

High School Diploma or equivalent.

Required Experience:

3 years of experience in customer service, claims processing, and/or provider network certification, or combination. Required Software and tools:
Microsoft Office. Working knowledge of DB2 or other database software. Required

Skills and Abilities:

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.

• Subsidized health plans, dental and vision coverage
• 401k retirement savings plan with company match
• Life Insurance
• Paid Time Off (PTO)
• On-site cafeterias and fitness centers in major locations
• Education Assistance
• Service Recognition
• National discounts to movies, theaters, zoos, theme parks and more

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.

Blue Cross is a strong supporter of our veterans, and many service men and women have joined our ranks. We’ve found the dedication, work ethic and job skills that serve well in the military excel in many of our lines of business, and we proudly have veterans filling positions in Human Resources, Information Technology, Customer Service, Operations, General Services and more.

Through our government contracts, we also have employees serving at Shaw Air Force Base, the Naval Health Clinic in Charleston, the Naval Hospital in Beaufort and in our hometown of Columbia, S.C., kson. If you are a full-time employee in the National Guard or Reserves, we will even cover the difference in your pay if you are called to active duty.

Blue Cross Blue Shield 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…