PGBA
ProviderFileSpecialist
Neural analysis suggests this role is
optimal for Mid+ candidates.
“Provider File Specialist at PGBA. Skills: establishing and maintaining certification and/or preparation, review and/or maintenance of healthcare provider files, provider directories, accurate/timely claims adjudication, provider billing, PIMS, AMMS. 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.. Verifies necessary/n”
What You'll Achieve.
Contributes to department's production standard
Industry & Context.
Good judgment skills
Ability to obtain a security clearance, U. S. Citizen, required to enroll in our health insurance, even if you already have other health insurance, occasional overtime, travel between buildings
What They're Looking For.
Must Have
1 year of administrative/clerical support, customer service, claims processing, and/or provider network/certification experience, 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, Microsoft Office
Nice to Have
Ability to learn DB2, SQL language to create/run PIMS queries for QC/research purposes
What You'll Do.
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.
Verifies necessary/needed information (written notifications
or telephone contacts) and/or establishes certification of healthcare service providers.
Prepares provider files/maintains provider data (updates
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
How You'll Work.
Team & Collaboration
Contributes to department's production standard; participates on special projects
Communication Scope
Demonstrated verbal and written communication skills
Process & Methodology
special projects, mass rate updates, quality improvement, audits
Full 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](https://pgba.com/) **–** one of BlueCross BlueShield's South Carolina subsidiary companies. **Location:** This position is full-time (40-hours/week) Monday-Friday. Work will be performed onsite at **8733 Highway 17 Bypass S, Myrtle Beach, SC, 29575.** 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. **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:** * 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
Applying for this Provider File Specialist role?
Most applicants get filtered before a human reads their resume. See if yours makes the cut.
How to Apply on Workday
- Workday has a multi-step form — save your progress after every section.
- "Apply With LinkedIn" can fail or lose data; manual entry is more reliable.
- Watch for the "Submit for Review" final step — hitting "Save" alone does not submit.
- Job requisition numbers are useful when following up with HR by email.
ANONYMOUS · UNFILTERED
What do employees actually say about PGBA?
Real rants from real employees. Read before you apply.