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SummaryResponsible 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.
DescriptionWhat 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.
Work environment: Typical office environment. May involve travel between office buildings.
To Qualify For This Position, You’ll Need
High School Diploma or equivalent.
Three (3) years of experience in customer service, claims processing, and/or provider network certification, or combination.
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.
Paid annual leave — the longer you work here, the more you earn
Nine paid holidays
On-site cafeterias and fitness centers in major locations
Wellness programs and a healthy lifestyle premium discount
Tuition assistance
Service recognition
What To Expect NextAfter 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 be conducting interviews with those candidates who qualify, with prioritization given to those candidates who demonstrate the preferred qualifications.
We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.
Some states have required notifications. Here's more information.
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 minorities, females, disabled individuals and 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 physical and mental disabilities.
If you need special assistance or an accommodation while seeking employment, please e-mail mycareer.help@bcbssc.com or call 1-800-288-2227, 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.
Seniority level
Mid-Senior level
Employment type
Full-time
Job function
Other
Industries
Information Technology & Services
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