Specialist, Provider File I-2

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

• Verify necessary information (written notifications, faxes, emails, or telephone contacts) and establish certification of healthcare service providers.
• Prepare provider files and maintain provider data (updates, additions, deletions) on the Provider Information Management System (PIMS) or appropriate provider system/database.
• Identify and assign providers to the appropriate network and provider system/database.
• Contribute to department production standards by working on PIMS and AMMS (Automated Medical Management Systems) maintenance/error reports.
• Participate in special projects such as mass rate updates, quality improvement initiatives, audits, and other related activities.

Requirements

• Education: High School Diploma or equivalent.
• Experience: 1 year of administrative/clerical support, customer service, claims processing, and/or provider network/certification experience.
• Skills and Abilities: Working knowledge of word processing and spreadsheet software; knowledge of or ability to acquire PIMS; good judgment; effective customer service and organizational skills; strong verbal and written communication; basic business math proficiency; ability to handle confidential or sensitive information with discretion.
• Software and Tools: Microsoft Office.
• Work Environment: Typical office setting; may involve travel between office buildings.

Preferred Qualifications

• Ability to learn DB2 and SQL to create/run PIMS queries for quality control or research purposes.
• Excellent telephone etiquette and prior customer service experience.

Benefits

• Subsidized health, dental, and vision plans (enrollment required as a Service Contract Act employee).
• 401(k) retirement savings plan with company match.
• Life insurance.
• Paid Time Off (PTO).
• On‑site cafeterias and fitness centers at major locations.
• Education assistance.
• Service recognition programs.
• National discounts to movies, theaters, zoos, theme parks, and more.

Schedule & Location

This is a full‑time (40‑hour/week) position, Monday‑Friday, working an 8‑hour shift during normal business hours (8:00 AM – 5:00 PM). Occasional overtime may be required based on business needs. The role is onsite at 200 North Dozier Boulevard, Florence, SC 29501, with occasional travel between office buildings.

Sponsorship

This position is not eligible for sponsorship now or in the future.