Network Contract Program Coordinator (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

This position is responsible for developing & reporting deliverables. Responsibility for facilitating various data management activities from Health Choice databases & systems and converting them into a workable report for the Network Team also falls under this role.

Qualifications

REQUIRED QUALIFICATIONS

Required Work Experience

• 2 years of experience in working with providers to manage their needs and expectations
• 2 years of experience in managed care contracting
• Knowledge proficiency in managed care concepts, including Medicaid and Medicare

Required Education

• Associate's degree in health care, business, information technology, related field, or equivalent job experience.

Required Licenses

• N/A

Required Certifications

• N/A

PREFERRED QUALIFICATIONS

Preferred Work Experience

• 2 years of experience in data analysis

1+ years of experience in performing network adequacy analysis Preferred Education

• Bachelors degree in health care analytics, information technology, , business, health care administration or related field

Preferred Licenses

• N/A

Preferred Certifications

• Project Management Professional - remove this.

Essential Job Functions and Responsibilities

• Work in collaboration across departments within the Medicaid Segment, internal and external business partners, and stakeholders, in support of operational goals and objectives
• Work closely with Network Contracting and Network Operations for business development,
• Work with BI on GEO mapping, provider performance measures, and regulatory requirements for all Medicaid Segment lines of business. Collect, analyze, and complete an initial review of provider data as requested & required for department regulatory reporting while establishing schedules to collect & interpret the data
• Provide ad hoc reporting as requested by department & health plan executives, querying data from Health Choice business operating systems & creating usable reports
• Serves as liaison with Business Intelligence and/or Med Econ in collaboration for specialized & specific data reporting requirements
• Collect data for provider directory & provider website for publication
• Processes data reports for leadership to identify opportunities to streamline processes, using both existing and soon-to-be available tools
• Validates data for accuracy and identifies gaps or trends.
• Notifies management of data concerns.
• 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

Required Job Skills.

• Knowledge of HIPAA transactions
• Knowledge of Medicare, Medicaid, and Affordable Care Act (ACA) regulations
• Knowledge of CMS, NCQA and AHCCCS reporting requirements
• Intimate knowledge of health care operating systems such as data warehouse, claiming systems and provider data management. Advanced spreadsheet and database knowledge
• Required Professional Competencies
• N/A

Required Leadership Experience and Competencies

• N/A

PREFERRED COMPETENCIES

Preferred Job Skills

• Knowledge of Microsoft Office suite with an intermediate level of proficiency
• Working knowledge of SharePoint, Power BI/Tableau, Visio, automated workflow applications

Preferred Professional Competencies

• Knowledge of internal departments and operations

Preferred Leadership Experience and Competencies

• N/A

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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.