Capital Blue Cross

Financial Planning and Analysis

• Lead subsidiary financial activities including compilation and analysis of financial statements and periodic financial materials
• Evaluate project financials for management reporting and prepare cost benefit analysis to support business decisions
• Serve as finance lead on key cross-functional teams supporting Dominion National Senior Team
• Collaborate with Dominion National business leaders to develop recommendations to Senior Team regarding optimal financial investments
• Support and improve the cost allocation process to deliver accurate segment financial performance reporting
• Compile and publish monthly management reports comparing financial performance to plan
• Establish benchmarking reports to identify opportunities for improvement
• Manage or serve in leadership role on key corporate initiatives as assigned
• Support business areas throughout the organization on financial related concerns

Financial Planning and Analysis Lead

Operations

This position organizes teams, develops plans, and facilitates project execution to achieve organizational goals.
Run a variety of projects small to very large, with a range of budget $50,000 to multi -million dollars and team sizes, across different areas of the organization with ease.
Ability to see big picture and convert strategies into workable initiatives is critical to success.
Propel the department forward by developing creative solutions to everyday problems with the goal of maximizing resources, minimizing costs, and advancing quality through a cycle of continuous process improvement.
Work as part of a high-performance contributor collaborating with all levels across the organization.
Contribute to the team's success by assisting with gathering and analyzing data using reporting capabilities and methodologies.
Foster an environment of critical thinking along with identifying and engaging key business and technical resources.

Network Process Manager

Risk

• Perform comprehensive review and oversight of medical records for Risk Adjustment compliance following CMS, HHS, and departmental guidelines
• Conduct clinical chart and patient billing audits to identify and validate reported diagnoses for Medicare Advantage and ACO members
• Review medical records and billing history to determine correct billing and documentation of disease conditions
• Adhere to Official ICD-10-CM and CMS risk adjustment guidelines ensuring accuracy, completeness, specificity and appropriateness of diagnosis information
• Leverage other sources (lab results, radiology, comorbid disease states) to find clinical evidence of disease categories
• Perform second-level audits and quality assurance checks on coding by peers or junior coders
• Conduct provider training on coding and documentation best practices
• Assist with production coding when needed and onboard new employees
• Participate in development and maintenance of SOPs, workflows, educational materials, and presentations
• Serve as mentor and lead communication with internal and external stakeholders regarding audit results and education plans
• Contribute to departmental process improvement initiatives and support special projects

Senior Risk Adjustment Coder – Government Programs

• The Member / Provider Services Representatives are the front-line team at Capital BlueCross and are responsible for handling all customer inquiries through multiple channels (phone, web, electronic, and/or face-to-face).
• Present and discuss our products and services, maintaining positive relationships and exceeding quality, productivity, and performance goals.
• Attend extensive training class and ongoing refresher trainings to service customers.
• Manage interfaces: Salesforce, Facets, Bridges, Workflow, Microsoft Office (Outlook, Word, Excel, PowerPoint), Availity, NICE InContact, Workbench, Prime RxClaims, TruCare.

Member Services Representative, Medicare Operations

Human Resources

• As a Senior HR Business Partner Sr, you will play a critical role in aligning HR strategies with business objectives. You will work closely with management and employees to foster a positive work environment, drive organizational effectiveness, and support the company’s growth and development. Your responsibilities will include strategic HR planning, talent management, employee relations and retention, management coaching, performance management, and change management.

Senior HR Business Partner

• Primary project lead on all Government Programs led and participant projects
• Implement projects for all Government Programs projects with urgency and due diligence regarding on time and on budget
• Drive projects forward leading and modeling behaviors, focusing on collaboration, accuracy, and raising issues and risks
• Be the first line of contact to project lead, taking action to mitigate risks or resolve critical issues
• Follow corporate project life cycle and masterful meeting guidelines holding others accountable to those guidelines
• Understand and follow Agile practices where appropriate
• Governance provides effective organization and support to project teams, while completing required deliverables in a complete and accurate fashion
• Secure acceptance of deliverables from appropriate leads
• Be a steward and role model of project management and all levels of governance
• Use Change Management guidelines to drive PMT and Drive Team approval regarding the use of resources (human and financial)
• Ensure projects are consistently closed within 45-60 days of go-live
• Make continuous improvement a priority and apply these principles to project work
• Consistently maintain focus on project budget and resources throughout the project life and ensure budget reconciliation is completed monthly
• Utilize the enterprise resourcing report to ensure that resources are appropriately captured, and actuals are being tracked in attempt to drive better resource management capabilities
• Engage business reengineering where appropriate to ensure solutions are enhancing existing processes
• Work seamlessly with vendors to ensure that projects move forward according to schedule
• Work with the team to develop and monitor Key Performance Indicators and Cost-Benefit Analysis to foster savings and alignment of project deliverables to strategic goals
• Ensure communication plans consider all stakeholders
• Monitoring all BCBSA deliverables within Government Programs and monitoring all audit activity to ensure we are meeting accuracy and timeliness within the regulatory requirements

Government Programs, Process Manager

Project Manager

• Manage large multi-faceted projects or multiple projects at the same time; organize teams, develops plans, and facilitates project execution.
• Lead governance and change management; secure acceptance of deliverables; ensure projects closed within 45-60 days of go-live.
• Manage budgets ranging from $50,000 to multi-million dollars; coordinate with vendors, legal, and other stakeholders; monitor KPIs and cost-benefit analyses.
• Mentor peers and lead governance; maintain effective communication plans and stakeholder engagement.
• Apply Agile practices and waterfall where appropriate; align with organizational goals.