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 1,400 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
Position focuses primarily on encounter data integrity. The Manager will be responsible for all roles within encounter data.  Which includes, analytics to identify errors in encounter data and find solutions; submissions - encounter new day and resubmission; tracking of all submissions and responses. Manger will work within the Medicare & Medicaid performance department under the umbrella of risk adjustment team.

Essential Functions and Job Responsibilities

• Managing EDI operations within production and test environments while proactively prioritizing encounters with incremental HCC value
• Submit encounter data to CMS in both test and production environments
• Work with encounter vendor (if applicable) to validate submissions and quality of submissions
• Provide excellent communication to internal and external teams
• Maintain knowledge of current Medicare Managed Care Manual
• 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

Required Qualifications1. Required Work Experience• 5 years of EDI transaction systems including EDI solutions for health plan business operations.• 5 years of technical development experience in business intelligence, data analysis, reporting, data engineering, data science, or informatics within healthcare industry• 2 years of experience with intermediate to advanced level SQL2. Required Education• High-School Diploma or GED in general field of study3. Required Licenses• N/A4. Required Certifications• N/APreferred Qualifications1. Preferred Work Experience• N/A2. Preferred Education• Bachelor’s degree in Computer Science, Information Systems, Mathematics, Economics, or Business Administration3. Preferred Licenses• N/A4. Preferred Certifications• N/A Required Competencies1. Required Job Skills• Technical experience of healthcare data and industry driven changes including EDI and Healthcare X 12 transactions• Intermediate understanding of CMS HCC regulations and methodology• Excellent understanding of the CMS cross-walk of ICD diagnosis codes to Hierarchical Condition Category (HCC) codes and impact of diagnosis coding on risk adjustment payment models• Advanced proficiency with MS Excel and Access including ability to create macros, pivot tables, charts, VLOOKUP, and work across multiple worksheets and workbooks to combine data.• Superior understanding of complex EDI opportunities around eligibility (834), claim status (276/277), encounters (837), response files (277CA/999/MAO-002), and risk adjustment data files (MAO-004)2. Required Professional Competencies• Excellent trouble-shooting, analytic and problem-solving skills• Ability to manage multiple tasks simultaneously in a demanding, fast-paced environment3. Required Leadership Experience and Competencies• N/APreferred Competencies1. Preferred Job Skills• N/A2. Preferred Professional Competencies• N/A3. Preferred Leadership Experience and Competencies• N/A 

Application Instructions

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