Systems Processor- Medicaid Jobs

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

• Scope of this position includes accountabilities that support the following programs:
• This is a specialized position focused on the maintenance, research, and root cause analysis of Business Systems related to the provider reimbursement cycle.
• Network Management
• Claims
• Finance

Qualifications
REQUIRED QUALIFICATIONS

• Required Work Experience

Processor/ Sr. Processor
1 year 3 years Experience in Claims, Network, and/or Customer Service
1 year 3 years Experience in processing role, managing inventory, meeting production and quality requirements.
2 years Experience in quality assurance 1 year Leadership and/or coaching experience

• N/A
• Required Certifications
• N/A
• Required Licenses
• Required Education
• High-School Diploma or GED in general field of study

Preferred Qualifications

• Preferred Work Experience

Processor /Sr. Processor
2 years 5 years Experience in Claims, Network, and/or Customer Service
2 years 5 years Experience in processing role, managing inventory, meeting production and quality requirements.
5 years Experience in quality assurance 2 year Leadership and/or coaching experience

• N/A
• Preferred Education
• Preferred Certifications
• Associate’s Degree in general field of study
• Preferred Licenses
• N/A

Essential Job Functions And Responsibilities
Systems Processor

• Identify, research, process, resolve, and respond to internal stakeholder inquiries via written communication or in person.
• Perform financial updates in strict accordance with BCBSAZ policies and protocols
• 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
• Maintain the data integrity of Business Systems
• Identify trends and root cause for issues affecting provider account receivables and work with various departments to resolve issues.
• Participate in the translation of negotiated contract terms into system and benefit structure
• Meet quality, quantity, and timeliness standards to achieve individual and department goals as defined within the department guidelines.
• Participate in small projects
• Maintain awareness of legislation, CMS website/instructions that impact provider issues
• Perform research for all provider types for all lines of business. Handle pended and rejected claims correcting edits and progress the claim adjudication workflow
• Demonstrate and maintain current working knowledge of the required BCBSAZ systems, procedures, forms and manuals
• Perform all other duties as assigned

Sr. System Processor

• Create and maintain accurate inventory reporting for Management
• Maintain professional working relationship with all stakeholders
• Serve as the Subject Matter Expert for all system inquiries. Remain the responsible point of contact until the matter is resolved
• Perform Quality Assurance as needed
• Manage work distribution among team members
• All System Processor competencies
• Work with ambiguous and conflicting information while keeping focused on the end goal

COMPETENCIES
Required Competencies

• Required Professional Competencies
• Intermediate PC proficiency
• Intermediate skill in use of office equipment, including copiers, fax machines, scanners, and telephones
• Intermediate level skill in word processing, spreadsheet, and database software
• Required Job Skills – Processor and Sr. Processor

Processor

• Maintain confidentiality and privacy
• Ability to navigate, gather, input, and maintain data records in multiple system applications with applicable accuracy
• Ability to problem solve
• Ability to work independently
• Ability to follow and accept instruction and direction
• Establish and maintain working relationships in a collaborative team environment
• Ability to interpret and translate policies, procedures, and guidelines

Sr. Processor

• Facilitate and resolve customer/provider requests and inquiries for all levels of management
• Perform complete root cause analysis
• Required Leadership Experience and Competencies – Processor and Sr. Processor
• Develop and maintain education and training materials
• Develop reporting as needed
• Master the skills and requirements of the Processor position
• Develop automation for gains in efficiency and accuracy

Preferred Competencies

• Advanced skill in word processing, spreadsheet, and database software
• Intermediate knowledge of medical and dental terminology
• Intermediate knowledge of health insurance reimbursement
• Preferred Professional Competencies
• Preferred Job Skills – Processor and Sr. Processor

Processor

• Knowledge of claims payment systems and the ability to perform preliminary claims research
• Driven and action oriented
• Knowledge of a wide range of subjects pertaining to the organization’s services and operations
• Analyze data in large databases/spreadsheets, and organize data into reportable results
• Knowledge of provider reimbursement methodologies contracts and networks
• Present information effectively, both verbal and written
• Identify and communicate process improvements
• Identify new or additional opportunities for data analysis

Sr. Processor

• Display team building skills and facilitate problem resolution
• Outcome focused, create reportable and measurable goals
• Provider support and guidance to other staff
• Experience presenting and leading meetings
• Preferred Leadership Experience and Competencies – Sr.
• Master the skills and requirements of the Processor position
• Experience in developing scripting for automation

Our Commitment
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.