Payment & Coding Strategist 1

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 twice per week

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

• Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): 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 week.

This position is remote within the state of AZ only.  This remote work opportunity requires residency, and work to be performed, within the State of Arizona.

LEVEL 1

• Work with others in the department to share responsibility for all claim pricing and coding policies for Commercial, Medicare and Medicaid products. Identify potential policy changes, compile impact analyses, and present recommendations to the appropriate work group for approvals.
• Ensure that pricing and coding policies are properly maintained and integrated into claims processing systems. Work with Corporate Medical Coders to triage issues and submit change requests.
• Hold primary or backup responsibility for managing vendors that provide primary code editing, secondary code editing or other related services. Track issues, submit change requests, and manage content releases for these vendor solutions.
• Explore, analyze and implement opportunities for reimbursement policy changes that support appropriate reimbursement goals, engaging with key business partners for final decisions.
• Work collaboratively with various business areas to provide data support, analysis, monitoring, trending, and reporting.
• Provide leadership and/or HVA representation on corporate committees, analyzing, interpreting and communicating information in formats that facilitate decisions and actions.
• Actively manage multiple aspects of cross-functional projects, identifying and driving key business decisions and gathering support across multiple divisions.
• Work with provider network and marketing to develop coding and reimbursement policy documentation for release to providers through a variety of channels (e.g. online, newsletters. etc.).
• Build and maintain effective working relationships with internal stakeholders and key external client contacts to ensure teamwork in achieving corporate goals.
• Manage informal relationships to get things done in the absence of direct reporting lines
• Responsible for defining and prioritizing own work, including backlog
• Work with team leaders and management to vet, refine and prioritize new project ideas

LEVELS 2 and 3

• Integrate HVA strategy into the execution process, including program management, project controls, communications and vendor oversight.
• Research latest developments by governmental and industry entities on the establishment of coding and reimbursement policies. Present findings and recommendations in written and verbal formats. Monitor external economic and healthcare issues affecting trends, preparing succinct, easy to understand presentations of results and conclusions.
• Communicate strategic initiatives and recommendations to various levels of senior management to support data-driven decision-making.
• Drive and execute complex and critical initiatives with minimal oversight
• Develop multi-year strategies, priorities and roadmap for HVA goals

ALL LEVELS

• Each progressive level includes the ability to perform the essential functions of any lower levels and mentor employees in those 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

competencies

REQUIRED COMPETENCIES

Required Job Skills

• Intermediate skill in database, spreadsheet, business intelligence tools, statistical, programming, and data visualization software
• Advanced skill in mathematical concepts, interpreting data and statistics
• Advanced analytical skills necessary to generate insights and recommendations based on available data
• Detailed knowledge of healthcare data elements & health insurance business concepts
• Project management skill needed to create timelines, track deliverables and progress, resolve issues, and communicate project status
• Ability to plan, organize and carry out multiple related activities simultaneously
• Advanced problem-solving and investigative skills
• Excellent computer skills including Microsoft Office (Word, PowerPoint, and Excel) and SharePoint Management
• Willingness and ability to learn new analytical programs

Required Professional Competencies

• Ability to recognize strategic opportunities and communicate how to use data/analytics to make timely and sound decisions
• Ability to define problems, collect data, establish facts, and draw valid conclusionsAbility to deal with the unpredictability of the insurance business and minimize the variance between predicted and actual outcomes.
• Ability and experience to assimilate multiple new functions, services, projects and systems while maintaining existing systems and programs.
• Excellent professional and interpersonal skills, including the ability to interface with senior/executive level management
• Ability to analyze data and determine creative ways to present the data to tell the story
• Ability to distill and communicate financial levers and impacts to non-technical audiences
• Skill in prioritizing tasks and working with multiple priorities, sometimes under limited time constraints
• Act with diplomacy and sensitivity with our internal and external business partners
• Ability to work at a high level without supervision
• Establish, contribute to and maintain a positive work environment

Required Leadership Experience and Competencies

• Strong influencing abilities to manage internal partners to accomplish key objectives and ensure promised deliverables are achieved.
• Management skills in an operationally changing environment, with drive for results and success based on planned objectives.
• Ability to engage and collaborate with team members and business stakeholders at all levels of the organization
• Ability to make decisions in a timely manner, sometimes with incomplete information and under tight deadlines
• Comfortable feeling ownership of the department and tackling work which may be out of scope of responsibilities
• High standard of performance while pursuing aggressive goals
• Principled leadership and sound business ethics

PREFERRED COMPETENCIES

Preferred Job Skills

• Extensive knowledge of all claim types (professional, outpatient, inpatient), code sets, and detailed claims data for all business segments (Commercial, Medicare and Medicaid).
• Proficiency in SAS
• Intermediate proficiency with development, testing, and management of Tableau Dashboards
• Advanced skill in database, spreadsheet, business intelligence, statistical, and data cubing software.

Preferred Professional Competencies

• N/A

Preferred Leadership Experience and Competencies

• N/A

Our Commitment

AZ Blue 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.

Thank you for your interest in Blue Cross Blue Shield of Arizona.  For more information on our company, see azblue.com.  If interested in this position, please apply.