Blue Cross Blue Shield of Arizona

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Provider Data Specialist and Reporting Analyst (experience in healthcare/Provider Partnership data analysis)

at Blue Cross Blue Shield of Arizona

Posted: 10/14/2020
Job Reference #: 6191
Keywords: technical, system

Job Description

Blue Cross Blue Shield of Arizona is a local, independent Blue Cross Blue Shield Association and a not-for-profit health insurance company headquartered in Phoenix. Founded in 1939, the company has more than 1,800 dedicated employees throughout its Phoenix, Tucson, Chandler and Flagstaff offices. Providing health insurance products, services and networks to more than 1 million Arizonans, Blue Cross Blue Shield of Arizona offers various health plans for individuals, families, and small and large businesses. Blue Cross Blue Shield of Arizona also offers Medicare supplement plans to individuals over age 65.

Blue Cross Blue Shield of Arizona helps to fulfill its mission of improving the quality of life of Arizonans by delivering 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.

 Provide Provider Partnerships operational areas with support for day to day operations including business and proccess analysis, production support, system implmentations and operational / mandated reporting. 

Level 1

WOrkflow Analysis

  • Central contact person for assigned workflow systems in terms of user support for process or system issues. Work independently to correct the issue and identify root cause.

  • Assist business areas in identifying potential system and/or process improvements to increase productivity or performance.

  • Work with internal development teams to clearly understand enhancement projects.

  • Analyze and define requirements through research, data gathering, and brainstorming activities. Conduct functional research and assessment of business needs and develop specifications.

  • Document business requirements of new capabilities in existing processes in enough detail that operational needs are clearly understood by the IT.

  • Escalate detailed project risks and issues to management and project manager.

    TESTING AND INTEGRATION

  1. Develop and execute detailed user acceptance test cases and expected results. Analyze and review test results with Users and IT to determine final acceptance.

  2. Assist in coordinating integration efforts of business process components for new enhancement(s). Assist in identifying process integration issues or vulnerabilities and report them to the appropriate team or management member(s).

    OPERATIONAL IMPLEMENTATION

  3. Develop training materials for staff in usage of any new system and/or workflow within the Provider Partnerships.

  4. Assist with training of business units as needed on appropriate work processes and assure that the business units implement the appropriate documentation in their respective areas.

    REPORTING

  5. General knowledge and experience utilizing database, word processing, and spreadsheet software.

  6. Ability to generate standard production metrics (quarterly, semi-annually, and yearly) and ad hoc requests.

  7. General knowledge of Provider Partnerships system of record reporting data sources.

    Level 2

    WORKFLOW ANALYSIS

  • Using process analysis techniques develop potential solutions (both short term and long term) for enhancing areas of assigned workflow systems; identify and document risks and benefits of solution(s) and develop implementation plan to best mitigate risk points.

  • Through analytical problem solving techniques perform assessment(s) of operational procedures. Identify business requirements and assist project team with selecting appropriate solutions to business problems or opportunities.

  • Analyze impact of systems design across all operational units and raise visibility to affected components.

  • Evaluate alternatives to strategies and develop business contingency plans where necessary.

    OPERATIONAL IMPLEMENTATION

  1. Assist in organizing and planning roll-out of new workflow functionality within the appropriate business departments.

    REPORTING

  2. Independently work on data requests with knowledge of BCBSAZ data sources and types.

  3. Determine provider data relationships within workflow processing systems.

  4. Identify provider inquires or issues that require review from Lead Analyst.

  5. Identify data anomalies or variations in which are directed to Lead Analyst.

    Level 3

    DEVELOPING BUSINESS REQUIREMENTS

  • Document business requirements of new capabilities for new processes in enough detail that operational needs are clearly understood by the IT engineering organization.

    TESTING AND INTEGRATION

  1. Coordinate with IT the requirements of a testing environment for the execution of user testing.

    OPERATIONAL IMPLEMENTATION

  2. Develop departmental level project plans as input to the entire project. These timelines are heavily concentrated on the workflow analysis, requirements gathering, and testing.

    REPORTING

  3. Advanced knowledge of BCBSAZ data sources and tools including Microsoft Applications.

  4. Ability to generate reports that meet the customers needs with high accuracy

  5. Ability to generate field mapping data dictionary for system of record applications.

  6. Advanced knowledge of Provider Partnership data sources and data integrity validation / escalation to Lead Analyst for review.

  7. Identify data anomalies or variations and provide potential reason or solutions to Lead Analyst for review.

  8. Identify provider inquires or issues and provide potential reason of solutions to Lead Analyst for review.

  9. General knowledge of advanced reporting tools, including but not limited to Six Sigma (Green / Blue belt).

    Level 4

    Workflow analysis

  10. Develop operational blue prints (business architecture) for new workflows.

  11. Analyze impact of systems design across all operational units and raise visibility to affected components.

  12. Evaluate alternatives to strategies and develop business contingency plans where necessary.

    DEVELOPING BUSINESS REQUIREMENTS

  13. Review and report discrepancies in systems design in accordance to project statement of intent, scope and business requirements to meet business objectives and expectations.

    TESTING AND INTEGRATION

  14. Coordinate integration efforts, performance of activities and delivery of services to ensure successful implementation of identified business solutions and business workflow processes within the Business Unit and between interdependent Business Unit(s).

    OPERATIONAL IMPLEMENTATION

  15. Organize, plan, and facilitate the roll-out of new workflows and functionality within the appropriate business departments.

  16. Plan and communicate implementation strategy within the Business/operational unit and between interdependent units.

    REPORTING

  17. Produce complex reports which require advance reporting tools and analysis.

  18. Ability to multitask complex reports, projects and task as required by BCBSAZ or mandates

  19. Ability to utilize all databases and reporting tools while maintaining accuracy with limited support.

  20. Demonstrates leadership skills by supporting corporate initiatives through reporting as requested by projects or teams. Can identify requirements through various types of communication.

  21. Facilitate resolution of provider inquires or issues

  22. Produce complex provider reporting with integration of multiple workflow processing systems.

  23. Produce provider partnership data integrity reporting with analysis of findings / recommendations.

  24. Communicate issues, concepts and criteria clearly to department management

    Level 5

    WORKFLOW ANALYSIS

  25. Advanced knowledge of divisional operating systems, software and programming.

  26. Ability to conceptualize applications from both a technical / programing perspective and a business point of view.  Create workflow diagrams to demonstrate functionality of programming based on business needs.

  27. Knowledge of various programming languages and frameworks with concentration of configuration and support of multiple infrastructure platforms.

  28. Monitor and support database maintenance for CareSpace including SQL Server tables, PCMH load file tool, payment breakout and PCMH dashboard.

  29. Oversight of CareSpace application, including Admin Tool, Development and Production.  Execute code builds to test and production environments.

  30. Knowledge of Cincom configuration, letter template development, testing and production execution.

    REPORTING

  31. Produce and develop additional department metrics to measure productivity and impact of the department.

  32. Audit reporting generated by Analyst Level 1-4 to ensure proper data gathering and reporting methods were used.

  33. Audit of department procedures to ensure staff compliance.

  34. Provide support and training to analyst within the department / division.

  35. Assist in the development and evaluation of compliance of department standard practices and guidelines.

  36. Produce metrics that are reported at the association level with high accuracy.

  37. Provide reporting needs outside of Provider Partnerships to support corporate / department / divisional goals.

  38. Evaluation of provider partnership data integrity findings that include downstream impact to internal / external business partners.

    ALL Levels

  • Each progressive level includes the ability to perform the essential functions of any lower levels.

  • 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.

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.

Skill / Requirements

Required Work Experience

5 years of experience in general business field

2 years of experience in process analysis field 

1 year of experience in Healthcare and/or Provider Partnership field 

  • 2 years of experience in programming or query development a healthcare environment (Applies to Level 5)

Required Education

  • High-School Diploma or GED in general field of study (Applies to All Levels)

Preferred Work Experience

5 years of experience in healthcare field (Applies to All Levels)

4 years of experience in business analysis / system implementation field (Applies to Levels 4 - 5)

4 years of experience with programming or query development in a healthcare environment (Applies to Level 5)

Preferred Education

Bachelor's Degree in IT or Business Related field of study (Applies to All Levels)

Preferred Licenses

Registered Nurse (RN) (Applies to All Levels)

Preferred Certifications

Six Sigma / Green or Blue Belt Certification (Applies to All Levels)

  1. Required Job Skills
  • Intermediate PC proficiency (Applies to Level 1)
  • Advanced PC proficiency (Applies to Levels 2 - 5)
  • Advanced PC skills in word processing, spreadsheet and database software (Applies to Levels 2 - 5)
  • Programming, auditing and coding of applications (Applies to Level 5)
  • Intermediate PC skills in word processing, spreadsheet and database software (Applies to Level 1)
  • Intermediate skill in use of office equipment, including copiers, fax machines, scanners and telephones (Applies to All Levels)
  1. Required Professional Competencies
  • Maintain confidentiality and privacy (Applies to All Levels)
  • Ability to set priorities (Applies to All Levels)
  • Analytical knowledge necessary to generate reports based on available data and then make decisions based on reported data (Applies to All Levels)
  • Capable of investigative and analytical research (Applies to All Levels)
  • Practice interpersonal and active listening to achieve high customer satisfaction and departmental communication standards (Applies to All Levels)
  • Establish and maintain working relationships in a collaborative team environment (Applies to All Levels)
  • Ability to work independently (Applies to All Levels)
  • Ability to interact with providers and external customers on a professional level and communicate their issues effectively (Applies to All Levels)
  • Test planning and execution (Applies to All Levels)
  • Document business requirements (Applies to All Levels)
  • Ability to manage projects with minimal supervisor and establish priorities (Applies to Levels 3-5)
  • Abiltiy to communication complex provider issues effectively (Applies to Levels 3-5)
 

Application Instructions

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