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Sup-Network Service Provider - Hybrid

AZ Blue Phoenix, AZ 85021, United States of America

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.

At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements:

  • Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week

  • Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week

  • Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per month

  • Onsite: daily onsite requirement based on the essential functions of the job

  • Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building

Please note that onsite requirements may change in the future, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per week.

This position is Hybrid within the state of AZ only.  This hybrid work opportunity requires residency, and work to be performed, within the State of Arizona.

PURPOSE OF THE JOB

The key component of this position is to educate providers regarding appropriate claims submission requirements, coding updates, electronic claims transactions & electronic fund transfer, while interfacing with the call center to compile, analyze, and disseminate information from provider calls.  This position needs to interface between multiple departments in order to identify and track & trend claims, coding, and internal processes as they relate to claims, and communicate findings to the provider.

REQUIRED QUALIFICATIONS

Required Work Experience

  • 2 years of experience in provider relations or customer service and claims with a managed healthcare plan and/or Medicaid & Medicare

Required Education

  • Bachelor’s degree preferred in Healthcare Administration or Business Administration or related field

Required Licenses

  • Valid Arizona Driver License, with an acceptable driving record

Required Certifications

  • Certified coder, medical billing, and coding certification

PREFERRED QUALIFICATIONS

Preferred Work Experience

  • 3 years supervising and leading successful teams
  • 2 years of provider relations, customer service and claims experience with a managed healthcare plan and/or Medicaid & Medicare

Preferred Education

  • N/A

Preferred Licenses

  • N/A

Preferred Certifications

  • N/A

ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES

  • Develop a team of all-star Provider Representatives
  • Lead, coach, train, and support staff activities
  • Collects, analyzes, and interprets provider data as requested and required for department regulatory reporting
  • Compiles data and contributes to the Network performance team and decision-making processes for business development including provider rep and provider performance measures and regulatory requirements for all LOBs
  • Provide direct oversight, instruction & guidance for Provider Representatives, to ensure compliance to policies and procedure and regulatory compliance
  • Provide direct and active assistance to Director in resolution of customer questions and service issues
  • Analyze and evaluate claims encounter data, data validation results, claim denials, and appeals/grievances data, to help determine provider claims and coding issues
  • Develop and establish reports to track & trend providers’ claims coding issues, and validate provider education/training
  • Coordinate with Provider Representatives for continuing education and communication with the provider community, both in-person and virtually
  • Analyze data and review with appropriate departments to ensure the accuracy of claims issues are addressed for providers
  • Develop & implement training/education in-services for providers, via office site visits, phone conferences, website updates, provider newsletters & provider forums
  • Assist with development and distribution of the provider manual, provider newsletter, and provider forums
  • Develop written materials to assist providers in following all policies and procedures
  • Routinely coordinate with the Provider Representatives to distribute appropriate materials to providers
  • Manages provider education and communications efforts for the company including content development, organization, administration and production of provider educational seminars, materials provider manual and other provider communication materials.
  • Perform all other duties as assigned
  • 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

REQUIRED COMPETENCIES

Required Job Skills.

  • Strong knowledge of claims & claims coding
  • Strong customer service skills & techniques
  • Microsoft Windows applications
  • Computer experience necessary
  • Effective time management skills
  • Ability to multi-task and prioritize work tasks to adhere to deadlines and identified time frames
  • Ability to make appropriate independent decisions

Required Professional Competencies

  • Strong presentation, oral & written communication skills
  • Ability to effectively interact with staff, customer & management at all levels
  • Effective interpersonal and communication skills
  • Ability to maintain positive work relationships
  • Ability to maintain a positive work environment for employees
  • Ability to work cooperatively, positively, and collaboratively in an interdisciplinary team

Required Leadership Experience and Competencies

  • N/A

PREFERRED COMPETENCIES

Preferred Job Skills

  • N/A

Preferred Professional Competencies

  • N/A

Preferred Leadership Experience and Competencies

  • N/A

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.

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