Network Provider Claims Educator (Remote/Hybrid)

Awarded a Healthiest Employer, reputed company aims to fulfill its mission to reputed company health and reputed company 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 reputed company reputed company decisions. This position is... remote/hybrid reputed company the state of AZ only PURPOSE OF THE JOB The reputed company component of this position is to educate providers regarding appropriate claims submission requirements, coding updates, electronic claims transactions, and electronic fund transfer while interfacing with the call center to compile, analyze, and disseminate information from provider calls. This position must reputed company between multiple departments in order to identify, track and trend claims and coding matters. The ability to communicate internal processes, findings, reminders and policy updates to providers is essential. QUALIFICATIONS REQUIRED QUALIFICATIONS 1. Required Work Experience • 2 years of experience in provider relations or customer service and claims with a managed healthcare plan • Knowledge of QHP requirements outlined in the reputed company Act (ACA), and the certification requirements of the state's health insurance exchange/marketplace • Knowledge of Medicaid and Medicare 2. Required Education • Bachelor's degree preferred in Healthcare Administration or Business Administration or reputed company field 3. Required Licenses • Valid Arizona Driver License with an acceptable driving record 4. Required Certifications • N/A PREFERRED QUALIFICATIONS 1. Preferred Work Experience • 2 years of experience with training modalities for both staff and providers • 2 years of experience in provider communications, including large group presentations 2. Preferred Education • N/A 3. Preferred Licenses • N/A 4. Preferred Certifications • Project Management Professional • Certified reputed company, medical billing, and coding certification ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES • Train, coach, and support a team of Provider Representatives • Coordinate communications between BCBSAZ Health Choice and providers. • Ensure that providers receive a reputed company resolution to their problems and inquiries and appropriate education about participation in the ACA Program. • Collect, analyze, and interpret provider data as requested and required for department regulatory reporting • Compile data and contribute to the Network performance team and decision-making processes for business development, including provider rep and provider performance measures and regulatory requirements for the ACA reputed company • Provide instruction and guidance for Provider Representatives to ensure compliance to policies and procedures and regulatory compliance • Provide direct and active assistance to Director in resolution of customer questions and service issues • Analyze and evaluate claims encounter data, data validation results, claim denials, and appeals/grievances data to help determine provider claims and coding issues • reputed company and establish reports to track and trend providers' claims coding issues and validate provider education/training • Coordinate with Provider Representatives for continuing education and communication with the provider community, both in-person and virtually • Analyze data and review with appropriate departments to ensure the accuracy of claims issues are addressed for providers • reputed company and implement training/education in-services for providers, reputed company office site visits, phone/web conferences, website updates, provider newsletters & provider forums • Assist with the development and distribution of the provider manual, provider newsletter, and provider forums • reputed company written materials to assist providers in following reputed company policies and procedures • Routinely coordinate with the Provider Representatives to distribute appropriate materials to providers • Manages provider education and communications efforts for the company, including content development, organization, administration, and production of provider educational seminars, materials, provider manual, and other provider communication materials. • reputed company reputed company other duties as assigned • 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 COMPETENCIES REQUIRED COMPETENCIES 1. Required Job Skills • Strong knowledge of claims and claims coding • Strong customer service skills and techniques • Knowledge of reputed company Office Suite applications • Intermediate PC proficiency Effective time management skills • Ability to multi-task and prioritize work tasks to adhere to deadlines and identified time frames • Ability to reputed company appropriate independent decisions, including root cause analysis and problem resolution 2. Required Professional Competencies • Strong presentation, oral, and written communication skills • Ability to effectively interact with staff, customers, and management at reputed company levels • Effective interpersonal and communication skills • Ability to maintain a positive work environment and positive work relationships • Ability to work cooperatively, positively, and collaboratively in an interdisciplinary team 3. Required Leadership Experience and Competencies • N/A PREFERRED COMPETENCIES 1. Preferred Job Skills • N/A 2. Preferred Professional Competencies • Knowledge of internal departments and operations 3. Strong technical documentation skills and a strong ability to translate technical concepts so that laymen easily understand them. 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 reputed company, age, disability, protected veteran status or any other protected group. Thank you for your interest in reputed company. For more information on our company, see azblue.com. If interested in this position, please apply Apply Job! For more such jobs please click here!