Provider File Specialist I

About the role

Responsible for establishing and maintaining certification and/or preparation, review and/or maintenance of healthcare provider files in support of provider directories, accurate/timely claims adjudication, and provider billing.

Responsibilities

• Verifies necessary/needed information (written notifications, faxes, emails, or telephone contacts) and/or 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 system/database.
• Identifies/assigns providers to the appropriate network and provider system/database.
• 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..

Requirements

• High School Diploma or equivalent
• 1 year of administrative/clerical support, customer service, claims processing, and/or provider network/certification experience
• Working knowledge of word processing and spreadsheet software
• Knowledge/understanding of or ability to acquire PIMS
• Good judgment skills
• Effective customer service and organizational skills
• Demonstrated verbal and written communication skills
• Basic business math proficiency

Qualifications

• Required Education: High School Diploma or equivalent
• Required Work Experience: 1 year of administrative/clerical support, customer service, claims processing, and/or provider network/certification experience

Skills and Abilities

• Ability to learn DB2, SQL language to create/run PIMS queries for QC/research purposes
• Excellent telephone skills and previous Customer Service experience

Schedule

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.

Benefits

• 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

Equal Employment Opportunity

We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. If you need special assistance or an accommodation while seeking employment, please email mycareer.help@bcbssc.com or call 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. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.