Program Lead- Provider Advancement Office-3-5 yrs leading business/system transformation in Provider Data/Credentialing
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.
Responsible for planning, organizing, staffing and managing work and resources to meet departmental and corporate goals related to the Velocity Provider future state platform. Advocate for and represent all Segments in prioritizing development and ongoing change management related to the Velocity Provider. Oversee and coordinate business needs to support integrations between future state system vendor, HealthEdge and other systems/applications and vendors as needed.
Required Work Experience
- 5 years of experience in healthcare industry
- 3-5 years of experience leading business or system transformation at a health plan in Provider Data Management and Credentialing functions
- 3 years of experience in leadership role with direct reports
- Bachelor's Degree in Management, Business Administration, Healthcare Management or Information Systems field of study
Preferred Work Experience
- 3-5 years of experience in Provider Network & Contracting, Provider Data Management, Provider Relations, and/or Provider Credentialing functions and processes
- 3 year(s) of experience in healthcare claim industry with a moderate understanding of claims processing from either a provider/hospital point of view or from a payer's point of view
- 6 year(s) of experience in managing and developing effective operational areas
ESSENTIAL job functions AND RESPONSIBILITIES
- Lead efforts to define the minimum viable product (MVP) for migration and ongoing support to the Velocity Provider future state platform, including implementation success criteria.
- Lead the successful implementation of the Velocity Provider future state system on time, within budget, while delivering MVP and defined success criteria.
- Lead efforts to utilize technology to develop and/or redesign processes, procedures, and systems. Identify improvement opportunities and coordinate the generation of business requirements.
- Responsible for ensuring user acceptance testing is completed and approved for changes across assigned areas.
- Lead efforts to support the configuration needs in Velocity Provider future state system, HealthEdge, and other systems/applications and vendors to support required functionality for the Velocity Provider scope.
- Work with organizational leaders to establish and manage budgets related Velocity Provider programs and projects.
- 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.
- Assure the proper change management and governance protocols are followed to maximize benefit and alleviate unnecessary disruption to the organization and the external customers.
- Establish and meet short- and long-term department goals in accordance with overall company objectives and divisional strategic planning
- 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 goals.
- Review and consult on the design and content of projects to ensure consistency across electronic submission platforms.
- 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.
- 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.
Required Job Skills
- Strong experience in Provider Data Management and Credentialing functions.
- Ability to articulate business strategy and define tactical roadmap to achieve.
- 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
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
- Strong understanding of information systems, business processes and the key drivers and measures fo success
- Customer service skills to deal with sensitive and difficult customer situations
- Independent thinker with strong oral, verbal and interpersonal communication skills
- Ability to clearly communicate at all levels (Executive, management, team, individual).
- Strong understanding of information systems, business processes and the key drivers and measures for success
- Strong decision analytical skills
- Budget management capabilities
- Working knowledge of Provider Data Management & Credentialing, claims processing and related operational functions
- 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
Required Leadership Experience and Competencies
- Ability to build high performing teams the delivery business and/or system transformation.
- 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
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
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
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
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