Provider Information Quality Assurance Specialist

We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally and serve our local communities. We invite you to apply for a career with Blue Cross.

Residency in or relocation to Louisiana is preferred for all positions.

POSITION PURPOSE

Provides daily guidance and support to the Provider Data Management team related to the review of quality errors, peer reviews and responding to audit inquiries for and from internal team members and other corporate departments. This position shall also be responsible for the review of accreditation, regulatory or other agency standards. Ensures that the team is familiar with NCQA and URAC accreditation standards, CMS requirements, State regulatory requirements and the tools used to monitor compliance and accreditation.

NATURE AND SCOPE

• This role does not manage people
• This role reports to this job: SUPERVISOR, PROVIDER INFORMATION
• Necessary Contacts: In order to effectively fulfill this position the incumbent must be in contact with: Network Operations, EDI, Network Development, Provider Services, Customer Service Units and other internal departments as needed; regulatory agencies, facility providers, practitioner providers, office managers, and provider licensing agencies.
  
  

Qualifications

Education

• High School Diploma is required.
• Bachelor's degree in business or a related field is preferred.
  
  

Work Experience

• 2 years of data quality review or audit experience is required; preferably in Provider Data Management.
  
  

Skills And Abilities

• Effective verbal and written communication skills are required.
• Must demonstrate the ability to work well within a team.
• Must demonstrate professional and ethical business practices, adherence to company standards, and a commitment to personal and professional development.
• Proven time management skills are necessary.
• Must demonstrate the ability to manage multiple priorities, deliver timely and accurate work products with a customer service focus, and respond with a sense of urgency as required.
• Demonstrated ability to work in a production focused environment preferred.
• Proven analytical, research and problem solving skills preferred.
• Proven ability to ask probing questions and obtain thorough and relevant information preferred.
• Customer Service focused with effective ability to empathize preferred.
• Exhibits an energetic, inquisitive, positive approach to problem solving preferred.
• Demonstrated ability to make decisions with little need for direction and to function effectively as a team-oriented, self-starter working across cross-functional lines preferred.
  
  

Licenses and Certifications

• None Required
  
  

Accountabilities And Essential Functions

• Performs audits and reports errors in accordance with departmental process and SLA’s for all team members on the Provider Data Management team to measure provider data accuracy and precision.
• Identifies trends, recommends changes to processes including workflows, assesses process deficiencies, and conducts one on one coaching and training.
• Produces daily educational bulletins to enhance quality as needed.
• Mentors and coaches new/more junior staff to educate and inform them on accreditation and regulatory standards.
• Works with business units in conducting gap analysis and/or review data/metrics to determine if a training solution is needed and if so, identifies what type of training is required.
• Participates in cross-functional meetings and work group sessions to identify improvement opportunities and ways to improve quality trend. outcomes.
• Assists Supervisor and the Training Coordinator with the modification of training resources/schedules in response to staffing issues and/or business needs.
• Monitors provisions and make recommendations to Service Level Agreements (SLAs) to ensure quality goals are met.
• Partners with the Provider Data Operations team to ensure the integrity of the end-to-end process is met within the provider data repository, PNO.
• Performs other relevant tasks as assigned by management.
• Accountable for complying with all laws and regulations associated with duties and responsibilities.
  
  

Additional Accountabilities And Essential Functions

The Physical Demands described here are representative of those that must be met by an employee to successfully perform the Accountabilities and Essential Functions of the job. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions

• Perform other job-related duties as assigned, within your scope of responsibilities.
• Job duties are performed in a normal and clean office environment with normal noise levels.
• Work is predominately done while standing or sitting.
• The ability to comprehend, document, calculate, visualize, and analyze are required.
  
  

An Equal Opportunity Employer

All BCBSLA EMPLOYEES please apply through Workday Careers.

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Additional Information

Please be sure to monitor your email frequently for communications you may receive during the recruiting process. Due to the high volume of applications we receive, only those most qualified will be contacted. To monitor the status of your application, please visit the "My Applications" section in the Candidate Home section of your Workday account.

If you are an individual with a disability and require a reasonable accommodation to complete an application, please contact recruiting@bcbsla.com for assistance.

In support of our mission to improve the health and lives of Louisianians, Blue Cross encourages the good health of its employees and visitors. We want to ensure that our employees have a work environment that will optimize personal health and well-being. Due to the acknowledged hazards from exposure to environmental tobacco smoke, and in order to promote good health, our company properties are smoke and tobacco free.

Blue Cross and Blue Shield of Louisiana performs background and pre-employment drug screening after an offer has been extended and prior to hire for all positions. As part of this process records may be verified and information checked with agencies including but not limited to the Social Security Administration, criminal courts, federal, state, and county repositories of criminal records, Department of Motor Vehicles and credit bureaus. Pursuant with sec 1033 of the Violent Crime Control and Law Enforcement Act of 1994, individuals who have been convicted of a felony crime involving dishonesty or breach of trust are prohibited from working in the insurance industry unless they obtain written consent from their state insurance commissioner.

Additionally, Blue Cross and Blue Shield of Louisiana is a Drug Free Workplace. A pre-employment drug screen will be required and any offer is contingent upon satisfactory drug testing results.

JOB CATEGORY: Insurance