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
 

50% 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. 20% Identifies/assigns providers to the appropriate network and provider system/database. 20% Contributes to department's production standard by working on PIMS and AMMS (automated medical management systems) or appropriate provider system/database maintenance/error reports. 10% Contributes to and participates on special projects, which may include but are not limited to the following: mass rate updates, quality improvement, audits, etc. 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. Preferred Software and Other Tools: Ability to learn DB2, SQL language to create/run PIMS queries for QC/research purposes. Work Environment: Typical office environment. May involve travel between office buildings.

 

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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.

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