Provider Account Executive (hybrid)

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue 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.

PURPOSE OF THE JOB

The Provider Account Executive is the sole point of contact for high profile facilities and groups. This role is responsible for coordinating all requests from their dedicated group(s) including claims issues, credentialing questions, roster verifications, precert coordination and other duties as assigned.

QUALIFICATIONS

REQUIRED QUALIFICATIONS

1. Required Work Experience

· 5 years experience in a provider relations role (level 1)

· 7 years experience in a provider relations role (level 2)

· 10 years experience in a provider relations role (level 3)

2. Required Education

· High-School Diploma or GED in field of study (Applies to All Levels)

3. Required Licenses

· Valid Arizona Driver License, with an acceptable driving record (Applies to All Levels)

4. Required Certifications

· N/A

PREFERRED QUALIFICATIONS

1. Preferred Work Experience

· N/A

2. Preferred Education

· Bachelor Degree (Applies to All Levels)

3. Preferred Licenses

· N/A

4. Preferred Certifications

· N/A

ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES

· Establish and maintain positive working relationships with assigned provider group(s)

· Facilitate at least monthly meetings with assigned groups to address concerns, share network updates, provide education, provide updates on corporate initiatives

· Ensure the resolution of provider inquiries and issues, identifying and escalating barriers to leadership for assistance

· Responds timely to provider calls and emails. Works collaboratively with internal teams to address provider complaints

· Ensure provider complaint tracking is completed and to the customer satisfaction

· Conduct and document provider visits. Provider visits must include reconciliation of provider rosters, review of any pertinent provider reporting including scorecards, quality reporting and other reports as identified. Provider visits may also include site visits of physician offices to comply with BCBSAZ requirements in conjunction with CMS.

· The position requires the Account Executive to attend monthly onsite staff meetings and other meetings in person, as required.

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 or special projects as assigned.

COMPETENCIES

REQUIRED COMPETENCIES

1. Required Job Skills

· Intermediate PC proficiency (Applies to All Levels)

· Intermediate skill using office equipment, including copiers, fax machines, scanners and telephones (Applies to All Levels)

· Intermediate skill in word processing, spreadsheet and database software (Applies to All Levels)

2. Required Professional Competencies

· Ability to present and interact at a professional level (Applies to All Levels)

· Ability to problem solve (Applies to All Levels)

· Maintain confidentiality and privacy (Applies to All Levels)

· Ability to prioritize and manage work assignments and work independently (Applies to All Levels)

· Knowledge necessary to analyze reports based on available data and then make decisions based on reported data (Applies to All Levels)

· Capable of investigative and analytical research (Applies to All Levels)

· Practice interpersonal and active listening to achieve high customer satisfaction and departmental communication standards (Applies to All Levels)

· Establish and maintain working relationships in a collaborative team environment (Applies to All Levels)

· Identify root causes and initiate solutions (Applies to All Levels)

· Ability to manage multiple large provider groups/hospitals (Applies to Levels 2 - 3)

· Ability to train entry level staff (Applies to Levels 2 - 3 )

· Ability to communicate complex provider issues effectively (Applies to All Levels)

· Demonstrates excellent relationships with providers (Applies to All Levels)

· Ability to manage high-level projects with minimal supervision (Applies to All Levels)

· Ability to demonstrate diplomacy in all situations (Applies to All Levels)

· Knowledge of claims and ability to perform claims research (Applies to All Levels)

3. Required Leadership Experience and Competencies

· Exhibit strong leadership skills (Applies to All Levels)

· Mentor and guide co-workers (Applies to Level 3)

PREFERRED COMPETENCIES

1. Preferred Job Skills

· Advanced skill in word processing, spreadsheet and database software (Applies to All Levels)

2. Preferred Professional Competencies

· Knowledge of provider reimbursement methodologies contracts and networks (Applies to All Levels )

Knowledge of claims payment systems and ability to perform preliminary claims research (Applies to All Levels)

3. Preferred Leadership Experience and Competencies

· Ability to positively influence others (Applies to Level 3)

· Considered role model for co-workers (Applies to Level 3)

Our Commitment

AZ Blue 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.