Network Provider Claims Educator (Remote/Hybrid)
Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.
This position is... remote/hybrid within the state of AZ only
PURPOSE OF THE JOB
The fundamental component of this position is to educate providers regarding appropriate claims submission requirements, coding updates, electronic claims transactions, and electronic fund transfer while interfacing with the call center to compile, analyze, and disseminate information from provider calls. This position must interface between multiple departments in order to identify, track and trend claims and coding matters. The ability to communicate internal processes, findings, reminders and policy updates to providers is essential.
QUALIFICATIONS
REQUIRED QUALIFICATIONS
1. Required Work Experience
2 years of experience in provider relations or customer service and claims with a managed healthcare plan
Knowledge of QHP requirements outlined in the Affordable Care Act (ACA), and the certification requirements of the state's health insurance exchange/marketplace
Knowledge of Medicaid and Medicare
2. Required Education
Bachelor's degree preferred in Healthcare Administration or Business Administration or related field
3. Required Licenses
Valid Arizona Driver License with an acceptable driving record
4. Required Certifications
N/A
PREFERRED QUALIFICATIONS
1. Preferred Work Experience
2 years of experience with training modalities for both staff and providers
2 years of experience in provider communications, including large group presentations
2. Preferred Education
N/A
3. Preferred Licenses
N/A
4. Preferred Certifications
Project Management Professional
Certified coder, medical billing, and coding certification
ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES
Train, coach, and support a team of Provider Representatives
Coordinate communications between BCBSAZ Health Choice and providers.
Ensure that providers receive a prompt resolution to their problems and inquiries and appropriate education about participation in the ACA Program.
Collect, analyze, and interpret provider data as requested and required for department regulatory reporting
Compile data and contribute to the Network performance team and decision-making processes for business development, including provider rep and provider performance measures and regulatory requirements for the ACA LOB
Provide instruction and guidance for Provider Representatives to ensure compliance to policies and procedures and regulatory compliance
Provide direct and active assistance to Director in resolution of customer questions and service issues
Analyze and evaluate claims encounter data, data validation results, claim denials, and appeals/grievances data to help determine provider claims and coding issues
Develop and establish reports to track and trend providers' claims coding issues and validate provider education/training
Coordinate with Provider Representatives for continuing education and communication with the provider community, both in-person and virtually
Analyze data and review with appropriate departments to ensure the accuracy of claims issues are addressed for providers
Develop and implement training/education in-services for providers, via office site visits, phone/web conferences, website updates, provider newsletters & provider forums
Assist with the development and distribution of the provider manual, provider newsletter, and provider forums
Develop written materials to assist providers in following all policies and procedures
Routinely coordinate with the Provider Representatives to distribute appropriate materials to providers
Manages provider education and communications efforts for the company, including content development, organization, administration, and production of provider educational seminars, materials, provider manual, and other provider communication materials.
Perform all other duties as assigned
The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week plus any additional hours as requested or as needed to meet business requirements
COMPETENCIES
REQUIRED COMPETENCIES
1. Required Job Skills
Strong knowledge of claims and claims coding
Strong customer service skills and techniques
Knowledge of Microsoft Office Suite applications
Intermediate PC proficiency Effective time management skills
Ability to multi-task and prioritize work tasks to adhere to deadlines and identified time frames
Ability to make appropriate independent decisions, including root cause analysis and problem resolution
2. Required Professional Competencies
Strong presentation, oral, and written communication skills
Ability to effectively interact with staff, customers, and management at all levels
Effective interpersonal and communication skills
Ability to maintain a positive work environment and positive work relationships
Ability to work cooperatively, positively, and collaboratively in an interdisciplinary team
3. Required Leadership Experience and Competencies
N/A
PREFERRED COMPETENCIES
1. Preferred Job Skills
N/A
2. Preferred Professional Competencies
Knowledge of internal departments and operations
3. Strong technical documentation skills and a strong ability to translate technical concepts so that laymen easily understand them. Preferred Leadership Experience and Competencies
N/A
Our Commitment
AZ Blue does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.
Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply
Apply Now
For more such jobs please click here!
This position is... remote/hybrid within the state of AZ only
PURPOSE OF THE JOB
The fundamental component of this position is to educate providers regarding appropriate claims submission requirements, coding updates, electronic claims transactions, and electronic fund transfer while interfacing with the call center to compile, analyze, and disseminate information from provider calls. This position must interface between multiple departments in order to identify, track and trend claims and coding matters. The ability to communicate internal processes, findings, reminders and policy updates to providers is essential.
QUALIFICATIONS
REQUIRED QUALIFICATIONS
1. Required Work Experience
2 years of experience in provider relations or customer service and claims with a managed healthcare plan
Knowledge of QHP requirements outlined in the Affordable Care Act (ACA), and the certification requirements of the state's health insurance exchange/marketplace
Knowledge of Medicaid and Medicare
2. Required Education
Bachelor's degree preferred in Healthcare Administration or Business Administration or related field
3. Required Licenses
Valid Arizona Driver License with an acceptable driving record
4. Required Certifications
N/A
PREFERRED QUALIFICATIONS
1. Preferred Work Experience
2 years of experience with training modalities for both staff and providers
2 years of experience in provider communications, including large group presentations
2. Preferred Education
N/A
3. Preferred Licenses
N/A
4. Preferred Certifications
Project Management Professional
Certified coder, medical billing, and coding certification
ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES
Train, coach, and support a team of Provider Representatives
Coordinate communications between BCBSAZ Health Choice and providers.
Ensure that providers receive a prompt resolution to their problems and inquiries and appropriate education about participation in the ACA Program.
Collect, analyze, and interpret provider data as requested and required for department regulatory reporting
Compile data and contribute to the Network performance team and decision-making processes for business development, including provider rep and provider performance measures and regulatory requirements for the ACA LOB
Provide instruction and guidance for Provider Representatives to ensure compliance to policies and procedures and regulatory compliance
Provide direct and active assistance to Director in resolution of customer questions and service issues
Analyze and evaluate claims encounter data, data validation results, claim denials, and appeals/grievances data to help determine provider claims and coding issues
Develop and establish reports to track and trend providers' claims coding issues and validate provider education/training
Coordinate with Provider Representatives for continuing education and communication with the provider community, both in-person and virtually
Analyze data and review with appropriate departments to ensure the accuracy of claims issues are addressed for providers
Develop and implement training/education in-services for providers, via office site visits, phone/web conferences, website updates, provider newsletters & provider forums
Assist with the development and distribution of the provider manual, provider newsletter, and provider forums
Develop written materials to assist providers in following all policies and procedures
Routinely coordinate with the Provider Representatives to distribute appropriate materials to providers
Manages provider education and communications efforts for the company, including content development, organization, administration, and production of provider educational seminars, materials, provider manual, and other provider communication materials.
Perform all other duties as assigned
The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week plus any additional hours as requested or as needed to meet business requirements
COMPETENCIES
REQUIRED COMPETENCIES
1. Required Job Skills
Strong knowledge of claims and claims coding
Strong customer service skills and techniques
Knowledge of Microsoft Office Suite applications
Intermediate PC proficiency Effective time management skills
Ability to multi-task and prioritize work tasks to adhere to deadlines and identified time frames
Ability to make appropriate independent decisions, including root cause analysis and problem resolution
2. Required Professional Competencies
Strong presentation, oral, and written communication skills
Ability to effectively interact with staff, customers, and management at all levels
Effective interpersonal and communication skills
Ability to maintain a positive work environment and positive work relationships
Ability to work cooperatively, positively, and collaboratively in an interdisciplinary team
3. Required Leadership Experience and Competencies
N/A
PREFERRED COMPETENCIES
1. Preferred Job Skills
N/A
2. Preferred Professional Competencies
Knowledge of internal departments and operations
3. Strong technical documentation skills and a strong ability to translate technical concepts so that laymen easily understand them. Preferred Leadership Experience and Competencies
N/A
Our Commitment
AZ Blue does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.
Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply
Apply Now
For more such jobs please click here!