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 states health insurance exchange/marketplace

Knowledge of Medicaid and Medicare

2. Required Education

Bachelors 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

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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.