Technical Information Specialist (RCD Claims) - Palmetto GBA

Summary

This position is part of our RCD (Review Choice Demonstration) Medicare Medical Review and Health Quality Team for Palmetto GBA. Position will be work from home after 4-6 months of onsite training in our Florence, SC office. To work from home, you must have high-speed non-satellite internet service and a private home office area.

Position Purpose

Responsible for the maintenance of records and the processing of claims in medical review along with any and/or all of the following: processes ingoing/outgoing mail and prepares work for nursing staff. Troubleshoots claims prior to nurse review and after review. Monitors timeliness of claims processing and adjusts claims keyed incorrectly. Performs quality control of work processes.

Description

Logistics:

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

Location:

• First four to six months will be onsite. Once training is complete and performance standards are met, you may work from home. Position will be work from home after 4-6 months of onsite training in our Florence, SC office ( 160 Dozier Blvd, Florence, SC 29501). To work from home, you must have high-speed non-satellite internet service and a private home office area.
• 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 8:00 AM - 5:00 PM. It may be necessary, given the business need to work occasional overtime.
  
  

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 McNamara-O'Hara 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 You’ll Do

• Processes denials of claims. Processes adjustment claims for both pre-pay and post-pay departments.
• Investigates and analyzes adjustment claim history and denial records.
• Prescreens records for review and maintains accurate records of all claims.
• Communicates with provider community and assists provider service department in responding to inquiries. Generates educational correspondence to providers regarding denials.
• Performs quality control of work processes.
• Assists manager with special projects.
  
  

To Qualify For This Position, You'll Need The Following

• Required Work Experience: One year administrative/clerical support AND Claims processing experience.
• Required Education: Associate's Degree OR two years of related work experience.
• Required Skills and Abilities: Working knowledge of word processing software. Strong analytical, organizational, and customer service skills. Strong verbal and written communication skills. Proficiency in spelling, punctuation, and grammar skills. Good judgment skills. Ability to handle confidential or sensitive information with discretion.
• Required Software and Tools: Microsoft Office.
  
  

We Prefer That You Have The Following

• Experience: Medical claims processing experience, strongly preferred.
• Skills and Abilities: Knowledge of medical terminology or coding.
• Software and Tools: Ability to work between various windows-based programs.
  
  

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.

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.