Provider File Specialist II
BlueCross BlueShield of South Carolina —Columbia, SC
- 8 hour shift
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Administrative Specialist II / Titling & Licensing Specialist II - 190631
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Administrative Specialist II (61035482)
State of South Carolina —Pickens County, SC
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14d
Eligibility Specialist II (MAGI) / 60018157
State of South Carolina —South Carolina
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- English
- Paid holidays
- Disability insurance
1d
Eligibility Specialist II (MAGI) / 61047506
State of South Carolina —Richland County, SC
- $36,491 a year
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1d
Laboratory Specialist II
University of South Carolina —South Carolina
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Employer Service Specialist II- Columbia, SC
State of South Carolina —Richland County, SC
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3d
County Administrative Support Specialist II / 61014405
State of South Carolina —Spartanburg County, SC
- $33,190 - $39,900 a year
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3d
Training Specialist II (PGBA)
BlueCross BlueShield of South Carolina —Florence, SC
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Provider File Specialist II

BlueCross BlueShield of South Carolina -
Columbia, SC

Apply Now

Job Details

Full-time

Benefits

Health insurance
Dental insurance
Paid time off
Vision insurance
401(k) matching
Employee discount
Life insurance

Qualifications

Statistics
Pricing
Confidential information handling
Medical claims processing
Medical software
Word processing
Spreadsheets
Basic math
English
High school diploma or GED
Health insurance knowledge
Data management
Data interpretation
Health information management
Productivity software
Grammar Experience

Full Job Description

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.

Description

Logistics: Palmetto GBA , – one of BlueCross BlueShield's South Carolina subsidiary companies.

Location: 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.

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). 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.

What You’ll Do:

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.

To Qualify for This Position, You'll Need the Following:

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.

Our Comprehensive Benefits Package Includes the Following:

We offer our employees great benefits and rewards. You will be eligible to participate in the benefits 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)
On-site cafeterias and fitness centers in major locations
Education Assistance
Service Recognition
National 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.

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 disabilities and 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 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 [email protected] 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. Here's more information .

Some states have required notifications. Here's more information .

Apply Now

Refine Your Search

specialist ii jobs in south carolina

Provider File Specialist II

Specialist, Training II

COMMUNICATIONS SPECIALIST II (DISPATCHER)

ADMINISTRATIVE SPECIALIST II - TEMP

Administrative Specialist II-Breast Health Center

Workforce Specialist II

Administrative Specialist II / Titling & Licensing Specialist II - 190631

Revenue Specialist I, II or III

Administrative Specialist II (61035482)

Eligibility Specialist II (MAGI) / 60018157

Eligibility Specialist II (MAGI) / 61047506

Laboratory Specialist II

Employer Service Specialist II- Columbia, SC

County Administrative Support Specialist II / 61014405

Patient Access Specialist, FT, Evenings, 2:51p-11:09p, Weekends and Hoildays

ADMINISTRATIVE SPECIALIST II-FT

ADMINISTRATIVE SPECIALIST II

Risk Adjustment Coder Professional Billing II, FT, Days, - Remote

Oncology Data Specialist (Program Coordinator II)-61005947

Training Specialist II (PGBA)

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