Systems Processor - Medicaid (AZ Remote)

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

At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements:

• Hybrid People Leaders: must reside in AZ, required to be onsite at least once per week

• Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per month

• Onsite: daily onsite requirement based on the essential functions of the job

• Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building

Please note that onsite requirements may change in the future, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per month.

PURPOSE OF THE JOB

· This is a specialized position focused on the maintenance, research, and root cause analysis of Business Systems related to the provider reimbursement cycle.

· Scope of this position includes accountabilities that support the following programs:

1. Claims

2. Finance

3. Network Management

QUALIFICATIONS

REQUIRED QUALIFICATIONS

1. 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

2. Required Education

· High-School Diploma or GED in general field of study

3. Required Licenses

· N/A

4. Required Certifications

· N/A

PREFERRED QUALIFICATIONS

1. 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

2. Preferred Education

· Associate’s Degree in general field of study

3. Preferred Licenses

· N/A

4. Preferred Certifications

· N/A

ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES

Systems Processor

· 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.

· Perform research for all provider types for all lines of business. Handle pended and rejected claims correcting edits and progress the claim adjudication workflow

· Participate in the translation of negotiated contract terms into system and benefit structure

· Perform financial updates in strict accordance with BCBSAZ policies and protocols

· Identify, research, process, resolve, and respond to internal stakeholder inquiries via written communication or in person.

· Meet quality, quantity, and timeliness standards to achieve individual and department goals as defined within the department guidelines.

· Maintain awareness of legislation, CMS website/instructions that impact provider issues

· Demonstrate and maintain current working knowledge of the required BCBSAZ systems, procedures, forms and manuals

· Participate in small projects

· 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

Sr. System Processor

· All System Processor competencies

· Manage work distribution among team members

· 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

· Work with ambiguous and conflicting information while keeping focused on the end goal

· Create and maintain accurate inventory reporting for Management · Perform Quality Assurance as needed