At HCSC, we consider our employees the cornerstone of our business and the foundation to our success. We enable employees to craft their career with curated development plans that set their learning path to a rewarding and fulfilling career.

Come join us and be part of a purpose driven company who is  invested in your future!

Job Summary

The Illinois Network Management team develops provider networks and reimbursement models, contracts with facilities and physicians across the state, operationalizes a variety of financial methods and payment models, with an emphasis on earned payments for quality and cost outcomes for BCBSIL members, and protects balances due to BCBSIL that these models generate. As a part of the Illinois Network Management team, the Illinois HMO Encounters team works with our HMO Medical Groups and our Third-Party Vendors on the submission, validation, and analysis of claim/encounter data via the 837 5010 Electronic Data Interchange (EDI) format. This position is responsible for working with large medical claim/encounter data sets to analyze and report on compliance with HMO and CMS requirements. This position is further responsible for using SQL programming in the analysis of managed care data, in the support/enhancement of applications, and in the interpretation of complex data requests for providing reporting solutions.

REQUIRED JOB QUALIFICATIONS:
* Bachelor Degree and 2 year experience in data analysis and information reporting data OR 4 year experience in data analysis and information reporting data.
* Analyze possible solutions using standard procedures to solve routine or basic problems.
* Use best practices and knowledge of internal or external business issues to improve products or services.
* Solve complex problems with guidance.
* Produce data sets and reports for analysis using SQL, Excel or other reporting tools.
* Verify accuracy of reports and provide insights.
* Knowledge of SQL, SAS and/or Teradata or other reporting tools / languages.
* Work with both internal and external data
* Work on multiple projects simultaneously, both independently and as part of a team to accomplish goals.
* Learn needed skills by performing assigned work

PREFERRED JOB QUALIFICATIONS:
* Bachelor Degree in Business, Mathematics or Computer Science
* Experience in use of membership data, premium data, and/or claims data
* Familiarity of Healthcare benefits, terminology, and concepts

* Knowledge of Industry Standard code sets (e.g. HCPC/CPT; Revenue Code; ICD10 Diagnostic Codes)

* Experience with risk adjustment encounter file preparation and remediation (e.g., 837 5010 files)

* Knowledge of diagnostic code capture strategies

We encourage people of all backgrounds and experiences to apply. Even if you don’t think you are a perfect fit, apply anyway - you might have qualifications we haven’t even thought of yet.

#LI-Hybrid

Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

HCSC Employment Statement:

HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.