Product Configuration Specialist-QNXT
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.
Pricing Configuration Analyst
235045 (Lev 1) (235046 Lev 2; (235047 Lev 3; 224045 Lev 4)
23 - 31
JOB LEVEL DEFINITIONS
- Level 1 Pricing Conf Analyst I (grade 23 - 24)
- Level 2 Pricing Conf Analyst II (grade 25 - 27)
- Level 3 Pricing Conf Analyst III (grade 28 - 30)Level 4 Pricing Conf Analyst- Lead (grade 31)
Purpose of the job
- Updates system configuration for the automated pricing functionality. Designs and develops pricing applications to support current operating system. Performs analysis and ensures accuracy of pricing design and implementation.
REQUIRED QUALIFICATIONSRequired Work Experience
- 1 year of experience with business requirement design and/or BCBSAZ production systems (Level 1)
- 3 years of experience in computer technology and/or information systems (Levels 2 - 5)
- 3 years of experience in data management and reporting (Levels 2 - 5)
- 3 years of experience working in healthcare-related systems as a systems analyst or programmer (Levels 3 - 4)
- High-School Diploma or GED in general field of study (All Levels)
Preferred Work Experience
- 5 years of experience in computer technology and/or information systems (All Levels)
- 7 years of experience in data management and reporting (All Levels)
- 5 years of experience working in healthcare-related systems as a business analyst or programmer (All Levels)
- 3 years of experience with QNXT configuration
- 3 years of QNXT provider and enrollment maintenance
- 3 years of experience with interpreting provider contracts, terms and fee schedules for provider configuration and maintenance
- 1 year experience with QNXT payment processing procedures
- Bachelor’s Degree in Computer Science, Information Systems, Business, or related field (All Levels)
ESSENTIAL job functions AND RESPONSIBILITIES
Level 1 - Entry-level role; Performs job functions under close supervision or peer review
- Research, analyze, track and resolve basic issues with claims, configuration, and pricing
- Develop business objectives, processing requirements, and specifications
- Perform basic configuration
- Develop basic test plans and scripts
- Perform basic data corrections
- Research and analyze procedural problems and provide recommendations for improvements and changes.
- Develop functional specifications, logic flows and other documentation as applicable
- Write or modify procedures for internal use, user operational areas and system use.
- Translate business needs into technical solutions
- Participate on small to medium scoped projects
Level 2 - Performs job functions with general supervision and peer review
- Research, analyze, track and resolve moderately complex system problems
- Perform basic to moderately complex configuration
- Build, support, and maintain basic to intermediate processes, programs, and data
- Provide annual coding update changes and upload fee schedules
- Participate or lead small to medium scoped projects
- Draft programs, time estimates and project schedules based on prioritization and business requirements
- Create basic ad-hoc reports for internal and external use
- Test system changes
Level 3 - Performs job functions with minimal supervision
- Provide peer-level review and mentoring to levels 1 and 2
- Participate and/or lead large- or complex-technical projects
- Evaluate high-level projects and assess components to forecast work effort; delegate components if appropriate
- Facilitate and/or create new procedures and processes that support advancing technologies or capabilities
- Research, analyze, track and resolve complex system problems
- Perform advanced configuration
- Perform advanced data corrections
- Build, support, and maintain moderately complex processes, programs, and data
- Create complex ad-hoc reports for internal usage and external usage
- Write technical specifications for reports and programming changes as well as conversion specifications and new system functionality
- Coordinate activity and responds to requests for analysis related to current data structures, input /output and associated entities.
- Ensure the department leverages internal tools and applications effectively
Level 4 - Performs job functions in a lead capacity
- Act as primary operational contact for internal and external customers when needed / in the absence of manager
- Ensure Service Level Agreements between department and operational or technical areas are met
- Lead, develop and mentor staff by providing opportunities for growth through delegation, training, and assignment to various project teams
- Inform manager of any issues impacting the efficient and effective performance of the department including system, resource, and informational barriers; Provide timely feedback to team member on performance
- Assist the manager in the day-to-day operations of the department
- Each progressive level includes the ability to perform the essential functions of any lower levels and mentor employees in those levels.
- Stay current on new developments in technology-related industries
- Participate in corporate quality 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. Participate in on-call rotation
- Perform all other duties as assigned
Required Job Skills (Applies to All Levels)
- Intermediate skill in use of office equipment, including copiers, fax machines, scanner and telephones
- Intermediate PC proficiency
- Intermediate proficiency in spreadsheet, database, charting, business intelligence and word processing software
- Intermediate knowledge of computer operating systems
- Basic knowledge of programming, database systems, and data management
Required Professional Competencies (Applies to All Levels)
- Strong analytical skills to support independent and effective decisions
- Ability to prioritize tasks and work with multiple priorities, sometimes under limited time constraints.
- Effective interpersonal skills and ability to maintain positive working relationship with others.
- Verbal and written communication skills and the ability to interact professionally with a diverse group, executives, managers, and subject matter experts.
- Systems research and analysis. Ability to write and present business intelligence documentation
- Ability to interpret medical, legal, and other technical data
- Knowledge of business requirements development and user acceptance testing.
- Maintain confidentiality and privacy
- Analytical knowledge necessary to generate reports based on available data and then make decisions based on reported data
Required Leadership Experience and Competencies
- Facilitate and resolve customer requests and inquiries for all levels of management within the Corporation. (Applies to Levels 2 - 4)
- Build synergy with a diverse team in an ever changing environment. (Applies to Level 4)
Preferred Job Skills (Applies to All Levels)
- Knowledge of HIPAA regulations and provider code sets
- Advanced proficiency in spreadsheet, database, flow charting, and word processing software
- Advanced knowledge of data mapping techniques
- Advanced knowledge of computer operating systems
- Advanced knowledge of provider contracting and associated reimbursement methodologies
- Strong knowledge of programming, database systems, and data management.
- Advanced knowledge of decision support systems
Preferred Professional Competencies (Applies to All Levels)
- Advanced systems research and analysis expertise
- Impeccable project management skills
- Solid technical ability and problem solving skills
- knowledge of internal departments and operations
Preferred Leadership Experience and Competencies (Applies to Level 4)
- Ability to provide mentoring and peer review to junior team members
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.
Imagine doing life-changing work and helping more than one million Arizonans live healthier and longer lives. That’s the kind of satisfaction you’ll find when you work here. Our exceptional teams in Phoenix, Tucson, Chandler, and Flagstaff have been transforming healthcare for more than 80 years. Explore what's possible with a career at Blue Cross® BlueShield® of Arizona