Information Technology Jobs in Cayce

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• Responsible for daily workflow activities to include the following membership/enrollment activities: processing of applications for new enrollments, terminations/cancellations, changes, renewals, database updates, and/or monthly billings.
  

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• 50% Receives and logs subscriber and member enrollment applications to the system. Processes/keys complex applications including new enrollments, terminations/cancellations, changes, and renewals. Updates all electronic enrollment files. Works edit/error reports generated from membership transactions.
  
• 15% Works with multiple operational areas to ensure relevant/appropriate group structure, status, benefits, and/or billing. May prepare and issue contracts, benefit books, and standard and custom id cards.
  
• 15% Responds to and resolves customer inquiries. Contacts plan administrators and internal and external customers to resolve issues/problems.
  
• 10% Trains new staff and updates/maintains accurate desk procedures. Assists with problem resolution.
  
• 10% Coordinates monthly billing and preparations of monthly invoices. May print, register, and mail monthly bills.
  

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• Ability to acquire knowledge of the membership system.
  
• Good judgment. Effective customer service and organizational skills.
  
• Demonstrated proficiency in spelling, punctuation, and grammar skills.
  
• Ability to persuade, negotiate, or influence others. Analytical or critical thinking skills.
  
• Ability to handle confidential or sensitive information with discretion.
  

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• Computer systems support knowledge.
  
• Knowledge of booklet id card preparation, underwriting enrollment regulations, contract formats.
  
• Knowledge of state and federal laws related to private business types of insurance.
  
• Knowledge of standard benefit structures.
  

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• 75% Determines methodology to identify cases for validation review. Conducts validation reviews/coordinates rates adjustments with appropriate claims area. Creates monthly/quarterly reports to present to each line of business providing information on records review, outcomes, trends, and savings that directly impact medical costs and contracting rates.
  
• 15% Manages records retrieval, release, HIPAA compliance, and all aspects of document management.
  
• 10% Serves as expert resource on methodology and procedures for medical records and coding issues.
  

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• Responsible for providing assistance in the acquisition, negotiation and renewal functions related to IT vendor contracts. Register vendors for IT contracts and manages databases for IT vendor contracts.
  
• 35% Assists in the acquisition, negotiation, and renewal functions related to IT vendor contracts. Reviews, analyzes and creates hierarchy for IT vendor agreements. Maintains and updates various IT vendor databases in support of area workflow and department projects.
  
• 35% Perform quality reviews of databases to ensure agreements are entered correctly. Works with staff to correct and advise of proper protocols.
  
• 10% Trains and assists new employees with processes and procedures of the databases. Creates work instructions, procedures and standards for databases.
  
• 10% Request vendor registrations from new and established vendors and assists IT Payables with finalizing the required documentation.
  
• 10% Creates, reviews, maintains, and completes various reports for management.
  

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• This position manages key vendor and contract activities, including requesting vendor registrations and assisting IT Payables with required documentation.
  
• Responsibilities include supporting renewal functions for critical IT vendor contracts, reviewing and analyzing reports for senior leadership, and collaborating closely with the Chief Negotiator, IS Negotiation team, and key vendors.
  
• The position also involves maintaining and updating IT vendor databases to ensure accurate workflow and support department projects.
  

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• Fast paced, multi-platformed environment which may require action and response 24X7 to support the technical business needs of the customer.
  

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• This department operates in a fast-paced environment, supporting a wide range of customers across BCBSSC and most of various lines of business. Our work often involves tight deadlines, with busy end of quarters, a very busy end of year for renewals, and at times it may require overtime to meet critical deliverables.
  
• We're a close-knit team that values collaboration and support. While we work in a high-functioning environment and pride ourselves on being hardworking, we also make space for fun and positivity.
  
• We partner closely with other teams across the AIMS organization. Our culture is a safe, inclusive space where everyone feels accepted and respected, and we welcome diverse perspectives.
  

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• 4 years project coordination or other related work experience.
  

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• Bachelor's Degree
  
• Degree Equivalency: 4 years job related work experience or Associate's and 2 years job related work experience
  

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• Excellent organizational skills and quality research skills.
  
• Excellent verbal and written communication skills.
  
• Demonstrated skills to work with and assist others.
  
• Ability to acquire in-depth knowledge of department functions, procedures and workflow.
  
• Analytical or critical thinking skills.
  
• Good judgment skills.
  
• Ability to handle confidential or sensitive information with discretion.
  
• Ability to work in a team environment and prioritize work effectively.
  
• Ability to assist in the preparation, documentation, and presentation of recommendations to management.
  

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• Microsoft Office.
  
• Vendor Management experience
  
• Experience communicating with executive level management
  
• Service Now Experience
  

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• Smart Cloud Control Desktop
  

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• Provides prompt, accurate, thorough and courteous responses to all customer inquiries.
  
• Inquiries may be non-routine and require deviation from standard screens, scripts, and procedures.
  
• Performs research as needed to resolve inquiries.
  
• 60% Ensures effective customer relations by responding accurately, timely, and courteously to telephone, written, web, or walk-in inquiries.
  
• Handles situations which may require adaptation of response or extensive research.
  
• Accurately documents inquiries.
  
• 15% Initiates or processes adjustments or performs other research as needed to resolve inquiries.
  
• Coordinates with other departments to resolve problems.
  
• Responds to, researches and/or assists with priority inquiries and special projects as required by management.
  
• 10% Provides feedback to management regarding customer problems, questions and needs.
  
• Maintains accurate records on complaints and/or other customer comments, and makes recommendations for changes to management.
  
• Follows through on complaints until resolved or reports to management as needed.
  
• 10% Maintains basic knowledge of quality work instructions and company policies.
  
• Assists with process improvements through the recommendation of changes in procedures and techniques discovered during daily operations.
  
• Maintains all departmental productivity, quality, and timeliness standards.
  
• 5% Assist with the training of new employees and cross training of coworkers.
  

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• 50% Performs medical or behavioral review/authorization process. Ensures coverage for appropriate services within benefit and medical necessity guidelines. Utilizes allocated resources to back up review determinations. Identifies and makes referrals to appropriate staff (Medical Director, Case Manager, Preventive Services, Subrogation, Quality of care Referrals, etc.). Participates in data collection/input into system for clinical information flow and proper claims adjudication. Demonstrates compliance with all applicable legislation and guidelines for all regulatory bodies, which may include but is not limited to ERISA, NCQA, URAC, DOI (State), and DOL (Federal).
  
• 25% Provides discharge planning and assesses service needs in cooperation with providers and facilities. Evaluates outcomes of plans, eligibility, level of benefits, place of service, length of stay, and medical necessity regarding requested services and benefit exceptions. Ensures accurate documentation of clinical information to support and determine medical necessity criteria and contract benefits. Collaborates with client's Care Management and other areas to ensure proper care management processes are executed within a timely manner. Manages assigned members and authorizations through appropriate communication.
  
• 15% Provides appropriate communications (written, telephone) regarding requested services to both health care providers and members.
  
• 5% Participates in direct intervention/patient education with members and providers regarding health care delivery system, utilization on networks and benefit plans. May identify, initiate, and participate in on-site reviews. Promotes enrollment in care management programs and/or health and disease management programs. 5% Maintains current knowledge of contracts and network status of all service providers and applies appropriately. Assists with claims information, discussion, and/or resolution and refers to appropriate internal support areas to ensure proper processing of authorized or unauthorized services.
  

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• 60% Provides active case management, assesses service needs, develops and coordinates action plans in cooperation with members, monitors services and implements plans, to include member goals. Evaluates outcomes of plans, eligibility, level of benefits, place of service, length of stay, and medical necessity regarding requested services and benefit exceptions. Ensures accurate documentation of clinical information to support and determine medical necessity criteria and contract benefits. Provides telephonic support for members with chronic conditions, high risk pregnancy or other at risk conditions thatconsist of: intensive assessment/evaluation of condition, at risk education based on members' identified needs, provides member-centered coaching utilizing motivational interviewing techniques in combination with reflective listening and readiness to change assessment to elicit behavior change and increase member program engagement.
  
• 20% Performs medical or behavioral review/authorization process. Ensures coverage for appropriate services within benefit and medical necessity guidelines. Utilizes allocated resources to back up review determinations. Identifies and makes referrals to appropriate staff (Medical Director, Case Manager, Preventive Services, Subrogation, Quality of care Referrals, etc.). Participates in data collection/input into system for clinical information flow and proper claims adjudication. Demonstrates compliance with all applicable legislation and guidelines for all regulatory bodies, which may include but isnot limited to ERISA, NCQA, URAC, DOI (State), and DOL (Federal).
  
• 10% Participates in direct intervention/patient education with members and providers regarding health care delivery system, utilization on networks and benefit plans. May identify, initiate, and participate in on-site reviews. Serves as member advocate through continued communication and education. Promotes enrollment in care management programs and/or health and disease management programs.
  
• 5% Maintains current knowledge of contracts and network status of all service providers and applies appropriately. Assists with claims information, discussion, and/or resolution and refers to appropriate internal support areas to ensure proper processing of authorized or unauthorized services.
  
• 5% Provides appropriate communications (written, telephone) regarding requested services to both health care providers and members.
  

Job Description Summary

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Job Description

Job summary: Under general supervision, the Certified Surgical Tech II follows established procedural guides in the preparation of sterile supplies and equipment used in the surgical procedures, performs appropriate room duties involved with direct patient care, and functions autonomously as a member of the operating room team. Demonstrates knowledge and skills,and behaviors consistent with competent practice.

Competency develops when candidates utilize higher level critical thinking and problem-solving skills. They should possess advanced relevant surgical skills for area of practice and apply their knowledge to emergency situations as they may arise in the operating room. Competent CST II’s use conscious, abstract reasoning and problem solving in planning collaboration with their peers to assess the needs of the patient and surgeon during the surgical procedure. Competent CST II’s practice autonomously in assisting with other duties such as assisting providers and nurses with vaginal deliveries, supply restocking, instrument flow, front desk customer service and engagement. Competent CST II’s are essential to the organization because of their efficiency, ability to set priorities and confidence in managing most situations within their clinical specialty. CST II’s may remain at a competent level indefinitely throughout their career. 

Required License Certification and Registration: Incumbent must hold and maintain the Certified Surgical Technologist credential administered by the National Board of Surgical Technology and Surgical Assisting, (formerly LCC-ST). If not certified, evidence of continuous employment in the state of South Carolina as a Surgical Technologist before January 1, 2008 is required.

Basic Life Support required.  Thereafter, must maintain a Current Basic Life Support (BLS), either a certification from an American Heart Association (AHA) BLS for Healthcare Providers (or AHA recognized equivalent) or an American Red Cross CPR/AED for Professional Rescuer and Healthcare Provider.

Minimum Experience and Training Requirements: High School Diploma. Graduation from an accredited school of surgical technology or surgical technology military program. At least one year of work experience as a Certified Surgical Tech required.

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Additional Job Description

Graduation from an accredited surgical technology program or surgical technology military program and a minimum of one year of work experience as a Certified Surgical Technologist required. The Level II practitioner demonstrates a higher level of critical thinking and problem solving skills and has met the Level I Certified Surgical Technologist criteria. Credentialed as a Certified Surgical Technologist (CST) by the National Board of Surgical Technology and Surgical Assisting (formerly LCC-ST) required and must be maintained. Current American Heart Association (AHA) Basic Life Support (BLS) certification or American Red Cross BLS for Healthcare Providers certification is required

If you like working with energetic enthusiastic individuals, you will enjoy your career with us!

The Medical University of South Carolina is an Equal Opportunity Employer. MUSC does not discriminate on the basis of race, color, religion or belief, age, sex, national origin, gender identity, sexual orientation, disability, protected veteran status, family or parental status, or any other status protected by state laws and/or federal regulations. All qualified applicants are encouraged to apply and will receive consideration for employment based upon applicable qualifications, merit and business need.

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