We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally and serve our local communities. We invite you to apply for a career with Blue Cross.
Residency in or relocation to Louisiana is preferred for all positions.
POSITION PURPOSE
This leader will be a part of BCBSLA's Provider Data Management transformation by leading Provider Data Management functions and key improvement activities, such as process improvement, business rules management, creating efficiencies and streamlining functions, as well as implementing system improvements.
NATURE AND SCOPE
Manages People
This role directly manages at least 3 workers
This role directly manages these jobs: Senior Provider Compliance Analyst, Provider Compliance Analyst, Special Provider Services Coordinator, Senior Provider Information Specialist, Provider Information Specialist
This role reports to this job: Director, Provider Network Operations
Necessary Contacts: In order to effectively fulfill this position, the incumbent must be in contact with:Network Administration, Benefits Administration, Provider Reimbursement & Audit, Medical Management, Legal, Financial Investigations, Marketing, IT, and Accounting to ensure that proper guidelines are being administered and answer any necessary questions. Regulatory agencies, Hospitals, Provider Licensing Agencies, Physicians, Ancillary Providers, Billing Entities, PHO Administrators and Governmental Agencies that may have questions with their contracting requirements.
QUALIFICATIONS
Education
Bachelor's degree in Business, Health Care Administration or related field is required
Four years of related experience can be used in lieu of a Bachelor's degree.
Work Experience
5 years of experience in a healthcare, hospital or related environment require
2 years of leadership required
Demonstrated Operational Process Improvement experience is required
Provider credentialing experience and experience with complex credentialing and provider systems (e.g. Cactus, Facets) preferred
NCQA and/or URAC experience preferred
Excel, Access, or SQL experience to analyze data and to develop reports to effectively forecast and manage work. preferred
Skills and Abilities
Critical thinking and the ability to question and challenge the status quo preferred
Excellent written and oral presentation skills, with the ability to engage, inspire, and build credibility and trust required
Ability to synthesize and summarize data for a broad audience preferred
Ability to multitask in a fast-paced production environment required
Strong organizational skills and time management required
Ability to take accountability for the work performed required
Ability to work under pressure to produce high quality work with defined turnaround goals required
Ability to effectively adapt to change required
Licenses and Certifications
None Required
ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS
Manages supervisory and / or staff level positions by administering all HR functions, including but not limited to, hiring, terminating, conducting performance reviews, managing work schedules, assigning and directing workload, training and developing staff, and coaching to help ensuring departmental, divisional, and/or corporate goals are obtained
Responsible for defining, planning, and leading the daily work associated with the processes and procedures, the data structure, and operational efficiencies of the provider data source systems that support the administration of provider information.
Develop, monitor, track, and report on established service level standards, compliance, and regulatory requirements.
Supports the integrity of the provider data for all participating and non-participating providers by ensuring that all provider information is entered accurately, timely, and efficiently to provide for proper claims adjudication, provider directory accuracy, and member access.
Leads process improvement and streamlining activities to improve the performance of operational functions.
Coordinates cross-functionality with a wide range of areas to meet provider needs, to implement projects, to address service/processing issues, to improve quality of service, and to implement useful and improved technology.
Reviews and analyzes data, reports, survey results, complaints, and performance information to develop strategies and executes detailed action plans to ensure excellent results and continuous improvement of service operation.
Collaborates with and develops effective relationships with other areas of the department to achieve the overall BCBSLA Provider Data Strategy.
Accountable for complying with all laws and regulations associated with duties and responsibilities.
The Physical Demands described here are representative of those that must be met by an employee to successfully perform the Accountabilities and Essential Functions of the job. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions
Perform other job-related duties as assigned, within your scope of responsibilities.
Job duties are performed in a normal and clean office environment with normal noise levels.
Work is predominately done while standing or sitting.
The ability to comprehend, document, calculate, visualize, and analyze are required.
LI_CB1
An Equal Opportunity Employer
All BCBSLA EMPLOYEES please apply through Workday Careers.
PLEASE USE A WEB BROWSER OTHER THAN INTERNET EXPLORER IF YOU ENCOUNTER ISSUES (CHROME, FIREFOX, SAFARI)
Additional Information
Please be sure to monitor your email frequently for communications you may receive during the recruiting process. Due to the high volume of applications we receive, only those most qualified will be contacted. To monitor the status of your application, please visit the "My Applications" section in the Candidate Home section of your Workday account.
If you are an individual with a disability and require a reasonable accommodation to complete an application, please contact recruiting@bcbsla.com for assistance.
In support of our mission to improve the health and lives of Louisianians, Blue Cross encourages the good health of its employees and visitors. We want to ensure that our employees have a work environment that will optimize personal health and well-being. Due to the acknowledged hazards from exposure to environmental tobacco smoke, and in order to promote good health, our company properties are smoke and tobacco free.
Blue Cross and Blue Shield of Louisiana performs background and pre-employment drug screening after an offer has been extended and prior to hire for all positions. As part of this process records may be verified and information checked with agencies including but not limited to the Social Security Administration, criminal courts, federal, state, and county repositories of criminal records, Department of Motor Vehicles and credit bureaus. Pursuant with sec 1033 of the Violent Crime Control and Law Enforcement Act of 1994, individuals who have been convicted of a felony crime involving dishonesty or breach of trust are prohibited from working in the insurance industry unless they obtain written consent from their state insurance commissioner.
Additionally, Blue Cross and Blue Shield of Louisiana is a Drug Free Workplace. A pre-employment drug screen will be required and any offer is contingent upon satisfactory drug testing results.
JOB CATEGORY: Insurance
