Project Consultant, Provider Network Analyst at Detroit

Job Description

Summary

Responsible for coordinating provider communications and records between AmeriHealth, Blue Cross Complete and Blue Care Network. Interface with external and internal customers to identify and/or analyze business problems and develop solutions. Managing the Blue Cross Complete Invalid Provider Queue process for providers whose credentials are not matched in the claims processing system. Provider Network Operations liaison between AmeriHealth and Blue Cross Complete and Blue Care Network Provider Consultants. Managing the Blue Cross Complete claims appeal process. Manage, investigate and submit correction forms for provider returned mail. Responsible for leading projects and teams to produce desired results. Interface with external and internal customers and vendors to identify and/or analyze business problems and develop solutions. Develop and improve workflows and business processes to improve customer service, decrease costs, and improve quality and efficiency.

Essential Duties and Responsibilities

• Develop detailed plans and schedules, identifying goals, objectives, risks and resource allocation.
  
• Monitor project status for significant deviations in quality, cost or schedule.
  
• Assist with the development of business cases for initiatives.
  
• Coach and mentor team members. Provide feedback on team performance.
  
• Ensure that expectations are developed, controlled, and executed in a timely manner.
  
• Interface with various departments, senior management and individuals external to Blue Cross Blue Shield of Michigan providing value and support for continuous improvement.
  
• Represent leadership staff at meetings in their absence.
  
• Perform other related duties as assigned.
  

Job Requirements

Education and/or Experience

• Bachelors Degree in related field required.
  
• Five (5) or more years experience in related field.
  
• Leadership and/or analytical experience with data, systems, and operations.
  
• Excellent analytical, organizational, problem solving, verbal and written communication skills.
  
• Significant creativity is required.
  
• Ability to work independently, within a team environment and with multiple priorities.
  
• Proficient in current industry standard PC applications and systems (e.g., Access, Excel and Word).
  
• Ability to work closely with the technical support team in understanding and resolving systems issues.
  
• Ability to develop, implement, and monitor policies and procedures.
  
• Some travel to business locations may be required.
  
• Other related skills and/or abilities may be required to perform this job.
  
• Analytical experience with data, systems, and operations.
  
• Ability to work closely with the provider support team in understanding and resolving provider configuration issues.
  
• Basic understanding of Michigan Uniform Billing Guidelines.
  

Country: USA, State: Michigan, City: Detroit, Company: Blue Cross Blue Shield of Michigan.