Network Business and Finance Conslt Assoc (Job Number:8231)
Description
Summary:
This position coordinates aspects of standard and non-standard provider contracts for lines of business and provider networks including managed care, open access and point of service delivery systems. This position implements provider data per contractual agreements and ensures that provider data payment information is loaded in the source provider systems that directs payment transaction processing. This position is also responsible for assisting, collecting and analyzing data, supports more senior level positions in carrying out projects. Provides documentation for projects. This position receives assistance/ direction from either management or principal(s) on the team.
Accountabilities:
1. Perform analysis, build, and maintain multiple tables in the TriZetto Pricer and PA&R system.
2. Set up and maintain provider networks, contracts, and perform network validation/testing, as needed.
3. Serve as a knowledge expert around the setup and maintenance of provider network Information.
4. Research and refine existing assumptions and procedures to present recommendation for change. Participate in design, development and maintenance of contracting projects. Research and responds to internal and external inquiries.
5. Identify workflow and system changes that will enhance the management of provider data.
6. Prepare reports and assist in research and analysis of data.
7. Perform audits of the provider data to ensure data quality and accuracy
8. This position assists senior positions in collecting and analyzing data to support department workload and special projects, performing experience analyses or developing assumptions. Documents methods, procedures and results.
9. Works with senior positions or management to understand and interpret the data to support projects and/or relevant data.
10. This position receives assistance/ direction from either management, principal(s) or senior(s) on the team and is able to work on multiple priorities, deadlines and has the ability to adapt to change.
Qualifications
Required Qualifications:
- Bachelor degree in Business, Accounting, Finance, Economics or related field and 2 years provider related or analytical experience, or a minimum of 6 years of provider related experience in lieu of a degree
- Microsoft Word and Excel experience.
- Proven ability to work in a team environment, assisting co-workers and achieving team goals.
- Excellent organizational skills with the ability to multi-task.
- Demonstrated knowledge of Provider Administration and Reimbursement (PA&R).
- Demonstrated analytical and problem solving skills.
- Proven ability to manage multiple projects.
- Excellent verbal and written communications skills.
Blue Cross and Blue Shield of Minnesota is an Equal Opportunity and Affirmative Action Employer, M/F/D/V. Blue Cross and Blue Shield of Minnesota is a drug free workplace. Candidates are required to pass a background check and drug test before beginning employment.
Primary Location: United States-Minnesota-Eagan
Description
Summary:
This position coordinates aspects of standard and non-standard provider contracts for lines of business and provider networks including managed care, open access and point of service delivery systems. This position implements provider data per contractual agreements and ensures that provider data payment information is loaded in the source provider systems that directs payment transaction processing. This position is also responsible for assisting, collecting and analyzing data, supports more senior level positions in carrying out projects. Provides documentation for projects. This position receives assistance/ direction from either management or principal(s) on the team.
Accountabilities:
1. Perform analysis, build, and maintain multiple tables in the TriZetto Pricer and PA&R system.
2. Set up and maintain provider networks, contracts, and perform network validation/testing, as needed.
3. Serve as a knowledge expert around the setup and maintenance of provider network Information.
4. Research and refine existing assumptions and procedures to present recommendation for change. Participate in design, development and maintenance of contracting projects. Research and responds to internal and external inquiries.
5. Identify workflow and system changes that will enhance the management of provider data.
6. Prepare reports and assist in research and analysis of data.
7. Perform audits of the provider data to ensure data quality and accuracy
8. This position assists senior positions in collecting and analyzing data to support department workload and special projects, performing experience analyses or developing assumptions. Documents methods, procedures and results.
9. Works with senior positions or management to understand and interpret the data to support projects and/or relevant data.
10. This position receives assistance/ direction from either management, principal(s) or senior(s) on the team and is able to work on multiple priorities, deadlines and has the ability to adapt to change.
Qualifications
Required Qualifications:
- Bachelor degree in Business, Accounting, Finance, Economics or related field and 2 years provider related or analytical experience, or a minimum of 6 years of provider related experience in lieu of a degree
- Microsoft Word and Excel experience.
- Proven ability to work in a team environment, assisting co-workers and achieving team goals.
- Excellent organizational skills with the ability to multi-task.
- Demonstrated knowledge of Provider Administration and Reimbursement (PA&R).
- Demonstrated analytical and problem solving skills.
- Proven ability to manage multiple projects.
- Excellent verbal and written communications skills.
Blue Cross and Blue Shield of Minnesota is an Equal Opportunity and Affirmative Action Employer, M/F/D/V. Blue Cross and Blue Shield of Minnesota is a drug free workplace. Candidates are required to pass a background check and drug test before beginning employment.
Primary Location: United States-Minnesota-Eagan