Job Description

Blue Cross Blue Shield of Arizona is a local, independent Blue Cross Blue Shield Association and a not-for-profit health insurance company headquartered in Phoenix. Founded in 1939, the company has more than 1,800 dedicated employees throughout its Phoenix, Tucson, Chandler and Flagstaff offices. Providing health insurance products, services and networks to more than 1 million Arizonans, Blue Cross Blue Shield of Arizona offers various health plans for individuals, families, and small and large businesses. Blue Cross Blue Shield of Arizona also offers Medicare supplement plans to individuals over age 65.

Blue Cross Blue Shield of Arizona helps to fulfill its mission of improving the quality of life of Arizonans by delivering 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.

Facilitate the publication of Medical Coverage Guidelines to provide guidance for members, providers and internal and external customers. 

Level 1 – Under the direction and review of the Level 2 Document Management Specialist:

  • Review, design, edit, reformat and maintain coverage guidelines
  • Publish Medical Coverage Guidelines (MCGs) internally on DocCenter and externally on BCBSAZ Internet provider and member portals
  • Weekly communication of MCGs update information to applicable areas of the corporation relying upon this information on a weekly or as needed basis
  • Respond to internal customer inquiries and requests for information regarding coverage guidelines
  • Provide/maintain the following:
  • Department policies and procedures
  • MCG development files
  • Meet quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines and required by State, Federal and other accrediting organizations
  • Maintain all standards in consideration of State, Federal, BCBSAZ and other accreditation requirements
  • Provider and vendor letters
     

Level 2 – Working independently:

  • Provide/maintain the following
  • Internet MCG tracking system
  • DocCenter MCG tracking system
  • Responsible for monitoring the access to all Medical Coverage Guidelines located on BCBSAZ Internet provider and member portals.
  • Perform internal (DocCenter) and external (BCBSAZ Internet provider and member portals) audits to maintain quality and resolve issues
  • Responsible for the training, development and support of grade level I staff under an established training program
  • Bi-monthly Medical Policy Panel meeting preparation
  • Accountable for maintaining all  HUM-1 documents to support URAC compliance
  • Develop and maintain DMS Policy & Procedures (P&P)
  • Finalize and publish department P&Ps; maintain P&P tracking system
  • Facilitates Informatics and IT reporting requests
  • Assists manager in policy and procedure development
  • Assists manager in development, revision and review of publication efficiencies
     
 

 

all levels

  • Each progressive level includes the ability to perform the essential functions of any lower levels.
  • 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.
  • Perform all other duties as assigned.
 

Within BCBSAZ and HCA, it is essential that we create a culture of inclusion and opportunity as well as actively guard against bias of any kind. Discrimination and racism are real. Our aim is to empower every member of our team to engage in our mission of improving health for Arizonans. We believe that the power and perspective of diversity and inclusion is in fact, essential to our success in serving clients, achieving our mission and creating a healthy environment for all.

BCBSAZ 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.

Skills / Requirements

  1. Required Work Experience
    • 3 year(s) of experience in office or clerical field (All Levels)
    • 1 year(s) of experience in document management field (Applies to Level 2)
  1. Required Education
  • High-School Diploma or GED in general field of study (All Levels)
  1. Preferred Work Experience
    • 1 year(s) of experience in healthcare, medical or insurance office or clerical field (All Levels)
    • 1 year(s) of experience in technical writing, journalism, document publication or related field (All Levels)
  1. Preferred Education
    • Associate’s Degree  in related field of study (All Levels)
    • Bachelor’s Degree in related field of study (All Levels)
  1. Required Job Skills (Applies to All Levels)
  1. Required Professional Competencies (Applies to All Levels)
    • Maintain confidentiality and privacy
    • Practice interpersonal and active listening skills to achieve customer satisfaction
    • Establish and maintain working relationships in a collaborative team environment
    • Follow and accept instruction and direction
    • Organizational skills with the ability to prioritize tasks and work with multiple priorities
    • Compose a variety of business correspondence
    • Independent and sound judgment with good problem solving skills
 

Application Instructions

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