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.

Purpose of the Job
Primarily responsible for working encounter data submissions for Encounter Data Systems (EDS). Develop desktop documentation, analyze, test, and identify errors in encounter data and find solutions; monitor resubmission status; and track all submissions and responses. This role will work within the quality management department under the umbrella of risk adjustment team.

Essential Functions and Job Responsibilities

Understanding of EDI opportunities around eligibility (834), claim status (276/277), encounters (837), response files (277CA/999/MAO-002), and risk adjustment data files (MAO-004)
• Understanding of production and test environments
• Submit encounter data to CMS in both test and production environments, as needed
• Prioritize encounters with incremental HCC value
• Work with encounter vendor (if applicable) to validate submissions and quality of submissions
• Technical experience of healthcare data and industry driven changes including EDI and Healthcare X 12 transactions
• Maintain current on new developments in technology-related industries.
• Participate in corporate quality and data governance programs.
• 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.

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

Qualifications Required Qualifications1. Required Work Experience• 2 years of experience in EDI and/or information systems• 2 years of experience in data analysis, data management and integration, extracting and analysis reporting. 2. Required Education• High-School Diploma or GED in general field of study3. Required Licenses• N/A4. Required Certifications• N/APreferred Qualifications1. Preferred Work Experience• 4 years of experience in computer technology and/or information systems• 2 years of experience working in healthcare-related systems as a business / systems analyst or programmer 2. Preferred Education• Bachelor’s Degree in Computer Science, Information Systems, Business, or related field3. Preferred Licenses• N/A4. Preferred Certifications• N/A Competencies Required Compentencies1. Required Job Skills• Experience with HEDIS and Medicare Part C & D Star Program analytics, or similar metrics (e.g., ECDS, SAMHSA's NOM, Medicaid Core, PQA)• Advanced skills and experience in database management, Access, Excel, (Pivot tables, V lookup, H lookup, conditional formatting).• Experience managing healthcare analytics-based data sets in a managed care or hospital environment• Intermediate experience with Microsoft Word and other MS Office Suite applications.2. Required Professional Competencies• Excellent time/project management skills, ability to work independently and meet deadlines/expectations; providing management with status updates and dashboards pertinent to HEDIS/STARs and quality and performance improvement programs for providers.• Ability to present comprehensive analytic results orally and in writing to medical offices, plans, and providers incorporating measure descriptions, relevant data, and other background material to provide context for results.• Ability to understand and accurately communicate complex regulatory and technical documents (e.g., regulations, contracts, performance measure technical specifications) to a variety of internal and external audiences. Public speaking and group presentation skills required.• Self-starter, resourceful and able to execute projects in a fluid and fast paced environment.• Ability to quickly learn and effectively use various software programs such as claims systems, QuickBase, and EMRs3. Required Leadership Experience and Competencies• N/APreferred Competencies1. Preferred Job Skills• Advanced using data analysis software (i.e., SAS, SPSS, SQL, Python, R, etc.)• Experience with working data visualization tools such as Qlik, SSAS or Tableau.2. Preferred Professional Competencies• N/A3. Preferred Leadership Experience and Competencies• N/A 

Application Instructions

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