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Provider File Specialist I

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BlueCross BlueShield of South Carolina

1mo ago

  • Job
    Full-time
    Junior Level
  • Logistics
    Healthcare
  • Florence
  • Quick Apply

AI generated summary

  • You need a high school diploma, 1 year of relevant experience, strong communication and organizational skills, and proficiency in Microsoft Office.
  • You will verify provider information, maintain provider data in systems, assign providers to networks, contribute to production standards, and participate in special projects like audits and quality improvements.

Requirements

  • 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.
  • Required Skills and Abilities:
  • 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.
  • Ability to handle confidential or sensitive information with discretion.
  • Required Software and Tools:
  • Microsoft office

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.

FAQs

What is the work schedule for the Provider File Specialist I position?

The position is full-time (40 hours/week) Monday-Friday, with shifts scheduled during the hours of 8:00 AM – 5:00 PM.

Where is the Provider File Specialist I position located?

This role is located on-site at 200 North Dozier Boulevard, Florence SC 29501.

What are the training hours for this position?

Training will take place Monday – Friday from 8:00 AM to 4:30/5:00 PM for approximately 6-8 weeks.

Is security clearance required for this position?

Yes, this position requires the ability to obtain a security clearance, which necessitates that applicants be U.S. Citizens.

What educational qualifications are required for this role?

A High School Diploma or equivalent is required for this position.

What work experience is needed to qualify for this job?

Candidates need to have at least 1 year of administrative/clerical support, customer service, claims processing, and/or provider network/certification experience.

What skills are necessary for the Provider File Specialist I position?

Required skills include a working knowledge of word processing and spreadsheet software, good judgment, effective customer service and organizational skills, demonstrated verbal and written communication skills, basic business math proficiency, and the ability to handle confidential information with discretion.

What software tools will I need to use in this role?

Proficiency in Microsoft Office is required, and familiarity with PIMS is necessary as well.

Does BlueCross BlueShield offer benefits, and when can employees enroll?

Yes, they offer a comprehensive benefits package, and employees are eligible to participate in benefits for the first of the month following 28 days of employment.

Is there an opportunity for career advancement within the company?

BlueCross BlueShield emphasizes the value of a diverse and inclusive workplace and provides opportunities for employees to develop their skills and advance their careers.

Is this position covered by the Service Contract Act (SCA)?

Yes, as a federal contractor, this position is subject to the Service Contract Act (SCA), and employees are required to enroll in health insurance benefits.

Are there any special accommodations provided for individuals with disabilities?

Yes, the company is committed to working with individuals with disabilities and providing reasonable accommodations on a case-by-case basis.

What are the primary responsibilities of a Provider File Specialist I?

Responsibilities include verifying necessary information for healthcare providers, maintaining provider files, contributing to departmental production standards, and participating in special projects like audits and quality improvement initiatives.

What types of projects will I work on in this role?

Projects may include mass rate updates, quality improvement initiatives, audits, and other special assignments as needed.

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BlueCross BlueShield of South Carolina

South Carolina’s largest and oldest health insurance company

Finance
Industry
10,001+
Employees
1946
Founded Year

Mission & Purpose

BlueCross BlueShield of South Carolina, the state's largest insurance company, has been a part of the national landscape for over six decades. With an A+ Superior rating from A.M. Best, the company is a leading government contract administrator and operates one of the most advanced data processing centers in the Southeast. BlueCross offers employees robust benefits, including retirement plans, health coverage, and education assistance, while fostering a culture of community support, with employees actively contributing to numerous nonprofit organizations each year.