Provider File Specialist I
Provider File Specialist I
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Job Description
Summary
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.
Description
Logistics:
PGBA is a subsidiary company of BlueCross BlueShield of South Carolina.
Location:
This position is fulltime (40 hours/week) MondayFriday in a typical office environment. Employees are required to have flexibility work any our 8hour shift scheduled during hours of 8:00 AM 5:00 PM. Training will be Monday Friday 8:00 AM 4:30/5:00 PM for approximately 68 weeks. This role is located on site at 200 North Dozier Boulevard Florence SC 29501
- Government Clearance: This position requires the ability to obtain a security clearance which requires applicants to be a U.S. Citizen.
- SCA Benefit Requirements: BlueCross BlueShield of South Carolina and its subsidiary companies have contracts with the federal government subject to the Service Contract Act (SCA). Under the McNamaraOHara Service Contract Act (SCA) employees are required to enroll in health insurance benefits regardless of other insurance coverage. Employees will receive supplemental pay until they are enrolled in health benefits 28 days after the hire date.
What Youll Do:
- 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 departments 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.
To Qualify for This Position Youll Need the Following:
- 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
We Prefer You Have the Following:
- Ability to learn DB2 SQL language to create/run PIMS queries for QC/research purposes.
Our Comprehensive Benefits Package Includes the Following:
We offer our employees great benefits and rewards. You will be eligible to participate in the benefits for the first of the month following 28 days of employment.
- Subsidized health plans dental and vision coverage
- 401K retirement savings plan with company match
- Life Insurance
- Paid Time Off (PTO)
- Onsite cafeterias and fitness centers in major locations
- Wellness program and healthy lifestyle premium discount
- Tuition assistance
- Service recognition
- Employee Assistance
- Discounts to movies theaters zoos theme parks and more
What We Can Do for You:
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.
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 conduct interviews with those candidates who qualify with prioritization given to those candidates who demonstrate the required qualifications
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 individuals with disabilitiesand protected 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 disabilities pregnant individuals individuals with pregnancyrelated 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 or callext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a casebycase basis.
We participate in EVerify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Heres moreinformation.
Some states have required notifications. Heres more information.
Required Experience:
Unclear Seniority
Employment Type
Full-Time
