Blue Cross Blue Shield of Arizona

Support Engineer

• Develops technical documentation and designs
• Analyzes, tests, and provides end user support
• Assists with analysis required for all Trading Partner EDI and flat files
• Participates in defect review meetings
• Creates Mapping Documents to move data between systems
• Facilitates and/or creates new procedures that support advancing technologies or capabilities

EDI Technical Analyst – Claims

Procurement

• Develop and maintain best practice Procurement to Pay (P2P) processes that maximize the value for the business, the experience for internal customers and the partnership with an inclusive supplier base.
• Manage and maintain supplier/vendor categories, support business case development for ongoing business needs and projects, and ensure strategic sourcing initiatives are embraced.
• Ownership of assigned category including spend analytics, category and supplier performance management, risk identification, analysis, and mitigation.
• Partner with internal stakeholders to understand business needs and align procurement strategies.
• Strategic engagement with supplier communities to develop and implement initiatives that enable profitable growth.
• Leverage market intelligence to validate and benchmark costs and competitive pricing.
• Develop product pricing/costing models that demonstrate value, impact, and opportunity.
• Lead RFx processes, contract negotiations and supplier selection, ensuring cost effectiveness & value add.
• Manage ongoing supplier relationships and execute supplier performance management initiatives in accordance with standards and guidelines and in collaboration with business partners.
• Manage multiple projects and initiatives within assigned categories with the ability to meet defined timelines and provide proactive status communication to business partners.
• Ensure compliance with all policy and procedures to ensure efficient and compliant operations.

Senior Category Manager – Professional Services

Consultant

• Responsible for supporting the UM/Care Management Department by providing professional oversight with an emphasis on regulatory requirements and those processes related to State, Federal, BCBSAZ, Accreditation and Medicare.
• Lead and coordinate or participate in the processes of initial delegation and ongoing oversight of delegated entities.
• Assist in various aspects of accreditation, delegation, and CMS activities.
• Develop and document health improvement/management programs for members in compliance with applicable state, federal, accreditation and Medicare regulations.
• Support business processes and data flows and how they affect health management/BCBS processes, systems and other operational areas.

Clinical Accreditation Program Consultant

IT Support

• Performs internal audit reviews
• Ensures accurate payment for all claim types and verifies demographic information is loaded correctly
• Conduct random quality audits of claims processed

Quality Control Technician – Claims Audit, Medicare/Medicaid

Financial Planning and Analysis

• Analyze and evaluate data in one or more specialty areas including business operations/processes, budgets, and financial systems
• Prepare financial reports
• Monitor budget
• Maintain records
• Analyze data
• Develop budget forecasts

Financial Analyst – Accountant

Manager

• Responsible for promoting continuity of care through a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates care options and services available to members through their benefit plan that meet the individuals' health care needs while promoting quality, cost effective outcomes.
• Responsible for case management functions but can assist with utilization management if a business need arises.
• Assess and collect data related to the member from all care settings.
• Interview and collaborate with case-related providers, member and family to implement the care plan.
• Answer a diverse and high volume of health insurance related customer calls on a daily basis.
• Explain to customers a variety of information concerning the organization’s services, including but not limited to, contract benefits, changes in coverage, eligibility, claims, BCBSAZ programs, provider networks, etc.
• Analyze medical records and apply medical necessity criteria and benefit plan requirements to determine the appropriateness of benefit requests.
• Present status reports on all cases to the manager/supervisor and, when indicated, to the medical director.
• Consult and coordinate with various internal departments, external plans, providers, businesses, and government agencies to obtain information and ensure resolution of customer inquiries.
• Meet quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines.
• Maintain all standards in consideration of state, federal, BCBSAZ, URAC, and other accreditation requirements.
• Maintain complete and accurate records per department policy.
• Demonstrate ability to apply plan policies and procedures effectively.
• Collaborate with team to distribute workload/work tasks; Monitor and report team tasks; Communicate team issues and opportunities for improvement to supervisor/manager; Support/mentor team members.
• Participate in continuing education and current development in the field of medicine, behavioral health and managed care at least annually.
• Perform all other duties as assigned.

EDI Technical Analyst – Claims

Senior Category Manager – Professional Services

Clinical Accreditation Program Consultant

Quality Control Technician – Claims Audit, Medicare/Medicaid

Financial Analyst – Accountant

Integrated Care Manager – Adult