Open Enrollment Readiness Lead
Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. BCBSAZ 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 is a remote opportunity within and outside the State of Arizona.
Pay: $90,000 - $130,000 per year
PURPOSE OF THE JOB
· End-to-End Program Lead is the point of contact responsible for organizing and managing migration and legacy incidents, features, and system issues in a command type group setting with key stakeholders. Serves as the bridge
between business and IT to the overall successful planning and execution of programs that positively impact the company’s goals for innovation, production, and growth. This role requires a strong blend of technical acumen with
excellent communication and strong organizational skills.
1. Required Work Experience
· 2 years of experience in leadership role
· 5 years of experience in project management
· 7 years of experience in a professional environment leveraging computer technology and/or information systems
2. Required Education
· High-School Diploma or GED in general field of study
3. Required Licenses
4. Required Certifications
1. Preferred Work Experience
· 8 years of experience in healthcare claim industry with a strong understanding of claims processing from either a provider/hospital point of view or from a payer's point of view
· 8 years of experience in managing and developing effective operational areas
· 3 years of experience in healthcare industry
2. Preferred Education
· Bachelor's Degree in Management, Business Administration or Information Systems field of study
3. Preferred Licenses
4. Preferred Certifications
ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES
· Lead efforts to ensure that the needs of the business are always addressed during each stage of the development cycle.
· Lead efforts to utilize technology to develop and/or redesign processes, procedures, and systems. Identify improvement opportunities and coordinate the generation of requirements.
· Responsible for ensuring user acceptance testing is completed and approved based on the business.
· Communicate all key project plans, commitments, and changes including requirements, QA plans, schedule, and scope changes.
· Review production and operating policies to ensure that the most efficient processes are in place and determine tactical plans to improve processes and services that can be streamlined and/or improved.
· Define and implement quality assurance procedures for all assigned activities. Implement quality assurance measures to check adherence to assure continuity, including across lines-of-business when appropriate.
· Assume leadership role in initiating and completing projects related to increased efficiencies, productivity, and quality as well as managing team relationships and collaboration.
· Establish and meet short- and long-term department goals in accordance with overall company objectives and divisional strategic planning.
· When necessary, facilitate collaboration sessions with key stakeholders when platform issues arise. Manage performance challenges and coordinate between the necessary teams to solution the situation.
· Identify root cause concerns, monitor service levels, key process indicators business expectations and environment usage.
· Support team members and develop and maintain appropriate training materials for new and existing team members.
· Maintain effective relationships with internal and external customers. Assure service level agreements are established, monitored and managed effectively. Implement action plans to resolve any issues preventing the area from meeting
· Lead and coordinate Go-Live activities, including managing related checklists and executing deployment plans.
· Responsible for release and development schedules across all HealthRules Payor and associated systems.
· Review and consult on the design and content of projects to ensure consistency across electronic submission platforms
· Assure the proper change management and governance protocols are followed to maximize benefit and alleviate unnecessary disruption to the organization and the external customers
· Provide recommendations in the development and design of new system logic to support legislative activity, medical policy changes, reimbursement methodology changes, provider contracting needs, etc.
· Oversee the development of business requirements and/or user stories to support system and/or process change
· Coordinate the identification, prioritization and resolution of issues with the various business areas and vendors
· Research new software development and configuration management methodologies and technologies, and analyze their application based on configuration and the needs of the business.
· 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.
1. Required Job Skills
· Intermediate skill in use of office equipment, including copiers, fax machines, scanner and telephones
· Intermediate PC proficiency
· Intermediate proficiency in spreadsheet, database and word processing software
2. Required Professional Competencies
· Work with all levels of management and functional areas in BCBSAZ and understand the potential implications of system changes to those areas
· Customer service skills to deal with sensitive and difficult customer situations
· Independent thinker with strong oral, verbal and interpersonal communication skills
· Basic understanding of information systems, business processes and the key drivers and measures for success
· Strong decision analytical skills
· Working knowledge of claims processing and related operational needs · Maintain confidentiality and privacy
· Capable of investigative and analytical research
· Analytical knowledge necessary to generate reports based on available data and then make decisions based on reported data
3. Required Leadership Experience and Competencies
· Provide leadership, promote teamwork, meet objectives and exercise independent judgment
· Experience leading and implementing projects and working collaboratively with other departments and levels of administration
· Strong organizational and management skills
1. Preferred Job Skills
· Advanced skill in use of office equipment, including copiers, fax machines, scanner and telephones
· Advanced PC proficiency
· Advanced proficiency in spreadsheet, database and word processing software
2. Preferred Professional Competencies
· Demonstrates flexibility, anticipates customer needs and effectively communicates in a timely manner consistent with the business strategy
· Advanced tactical planning and decision analysis skills
· Cope with multiple priorities and high customer expectations and bridge the demands between internal and external customers
· Creativity and problem solving skills
· Develop methods and processes to disseminate complex information
· Plan and manage business strategy effectively and thoroughly
· Mentor less experienced staff
· Advanced understanding of information systems, business processes and the key drivers and measures for success
· Advanced analytical and diagnostic skills dealing with issues that are often novel and not readily defined, lack known precedent or appear contradictory · Develop solutions by applying accepted processes or is able to create new approaches to leverage technology from abstract information
· Advanced understanding of HIPAA transactions and codes sets · Presentation and public speaking abilities
· Development and application of budgeting concepts, processes and procedures
· Advanced project management skills
· Advanced technical and business knowledge of Internet and HIPAA transaction requirements to identify production issues and effectively communicating issues to IT and other areas as necessary
· Create business requirements, technical specifications, test plans and test scripts
· Understanding of a clearinghouse and other EDI systems
· Interpret medical, legal and technical data, including state and federal regulations and their effect on operations
· Conceptualize new business architecture and infrastructure
3. Preferred Leadership Experience and Competencies
· Identify resources and training needs while fostering opportunities for staff growth Promote and supports the overall quality principles and company quality program
· Empower associates at all levels and encourage innovation and risk taking · Develop an enthusiastic and positive work environment
· Negotiation and influencing skills with the ability to create win/win situations · Resource management skills
· For Senior Manager: Requires the skills, experience and leadership abilities to serve as the designated back-up for the Director
· For Senior Manager: Educate and mentor department managers on leadership techniques, staff consulting, work management, etc.
· For Senior Manager: Provide management coverage for any area within the department as needed
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.
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.