Current Career Opportunities

Responsibilities

• Complete a program comprised of classroom and on-the-job training that will provide the technical knowledge and customer service skills needed to accurately answer most member and provider questions.
• Learn and utilize customer service skills in order to successfully handle all customer interactions in a consistent, courteous, and professional manner.
• Accurately document, track, and research all inquiries in Customer Focus (CF) according to department guidelines and written procedures.
• Achieve a level of call volume and quality goals as set forth in the Customer Service Career Pathing Guidelines. Successful achievement of these goals will help enable to CSR to transition to a Customer Service Representative II position.

Qualifications

• High school graduate or equivalent required.
• Analytical and critical thinking skills required.
• Computer literacy, strong typing and spelling skills required.
• One to two years of successful customer service experience, preferably in a health insurance or health care setting is desired.
• The ability to multitask, problem solve and work independently is necessary.

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Responsibilities

• Serve as the primary point of contact, consultative resource and subject matter expert for providers as it relates to Qualified Health Plan (QHP) Risk Adjustment.
• Educate practitioners and office staff on processes related to Risk Adjustment and best practices.
• Meet regularly with internal and external stakeholders and leaders to review provider performance and formulate tactics to facilitate continuous improvement.
• Educate practices on accurately depicting a member’s health status through accurate documentation and coding at the provider level to ensure that the Blue Cross plan’s risk score is as accurate as possible.
• Share gap reports with provider offices and internal partners as necessary.
• Use existing resources to collaborate with provider offices and internal partners on gap closure barriers as well as best practices for documentation and coding. 
• Work closely with provider groups and their staff to close gaps and assist in having members seen in offices yearly.
• Work primarily through personal contact with the provider community and travels up to 25% of the time.

Qualifications

• Bachelor’s degree, or equivalent combination of education and experience.
• Two or more years of clinical practice experience in a provider’s office, hospital setting, health plan or comparable environment required, preferably with experience in provider engagement/performance programs.
• Direct experience working with providers and/or in a provider’s office.
• Advanced oral, verbal, written, and presentation skills and a strong presence or in person, online and telephone engagement. Advanced ability to read and comprehend clinical text found in medical records with attention and appreciation for detail.
• Experience with clinical documentation and/or formal coding certification from American Academy of Professional Coders (AAPC) or American Health Information Medical Association (AHIMA) strongly preferred.

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Responsibilities

• Provide data, reporting, and analytical expertise to strategic teams focused on provider reimbursement and value-based care initiatives.
• Calculate, monitor, and track performance, use data to support informed business decisions, and participate in the decision-making process. 
• Prepare financial and utilization models to illustrate the impact of changes to provider reimbursement, contract provisions, medical policies and practices, benefit plans, products, and quality improvement activities.
• Prepare and maintain documentation related to standard operating procedures as well as routine and special projects.
• Participate in meetings with external parties (employer groups, providers, regulators, etc.), develop presentations, and convey information to advance the Plan’s strategic objectives and fulfill the Plan’s obligations.
• Mentor junior staff as required

Qualifications

• Bachelor’s degree in health care, business, statistics, math or a closely related field required, advanced study desirable.
• 5-7 years of closely related experience with one to three (1-3) years of demonstrated independent work required. 
• 3-5 years of managed care and health insurance experience, including experience in reimbursement methodologies, data research and reporting preferred. 
• Knowledge of commercial and Medicare payment methodologies strongly preferred. 
• Advanced Microsoft Excel required, and SAS programming knowledge strongly preferred.

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