Design, develop and implement standard plan or provider financial and operational reports in response to customer requirements and business needs Lead and implement internal controls; facilitate definition of data and other information requirements; define efficient data
Strategic Planning & Enterprise Alignment Support the President & COO in setting enterprise strategy, shaping organizational focus, and coordinating across business functions. Serve as a central orchestrator between strategy development and execution, partnering closely with the
Manage CFR Team You are responsible for leading and managing the contracting function in Provider Services and overseeing the work of the employees in the CFR department as well as outside contracted vendors. These responsibilities include,
Facilitates complex projects and functions of high importance as an independent project lead. Plans and manages the project development process and oversees implementation. Analyzes intricate project objectives, data sources, methodology, data summaries and findings, and prepares
Oversee management and staff responsible for implementation and administration of Provider Reimbursement methodologies, including, but not limited to: Institutions, Professionals, and ancillary providers. Provide management reports and analysis needed for decision making, physician and institutional contracting,
Cross-Functional Project Team Leadership and Participation: Lead project staff and subject matter experts with the planning and implementation of project and sub-project work efforts. Lead, coordinate, facilitate, and/or participate in cross functional teams to plan and
Research and Analysis: Research and respond to low complexity internal and external inquires. Use a variety of resources including, but not limited to on-line information files and databases, peer guidance, interviews with internal departments including clinical
Monitor all incoming, online requests for information and assign to the appropriately trained Customer Relations staff person. Multiple factors including the requesters plan type, employer group, authorization level, and other external factors including work queue volume,
Responsible for analysis, design, modeling and architecture for application systems and domains. Manages the maintenance and support of assigned application system(s). May participate in development, maintenance and support activities. Leads or participates in the project planning
Stakeholder Engagement Builds and sustains strong relationships with executive leaders, business partners, and external stakeholders to advance strategic priorities and enterprise alignment. Evaluates complex business challenges and guides the development of innovative, scalable solutions that support
Develop goals and objectives for performance management program to ensure maximum performance of staff. Provide guidance, coaching and mentoring through the performance management process. Ensure staff remains committed and motivated to meet goals and objectives. Manage
Performance Meet established marketing plan goals, and achieve annual sales revenue and membership growth objectives by effectively promoting and closing prospective sales opportunities. Perform quick and efficient transaction fulfillment of telephone calls or email from prospective
Revise and/or develop medical policies adopted from the BCBSA in conjunction with assigned medical director and in accordance with Development and Approval of Medical Policy administrative policy; process includes appropriate and timely implementation and publication. Assist
Provides and interprets all program guidance internally regarding Inter-Plan Program policies and manuals being accountable for all Inter-Plan governance and policy matters. Monitor and effectively manage inventory of unresolved complex inquiries to provide timely follow-up and
Ensures proper recordation and reporting of various financial transactions for the Association and its Subsidiaries. Communicate with other F&A staff and internal departments to record and reconcile the following: Prepare and post accruals for various general
Executive Support Provide high-level administrative and strategic support to the Executive and department leadership, exercising independent judgment to ensure effective use of leadership time and focus. Manage the Executives calendar and schedule balancing priorities, proactively resolving
Project Support and Documentation: Works closely with the project team to support the development of artifacts and project material used in the project management process. Supports the collection of project performance data and develops reports and
Under the general guidance of the Audit Manager: Perform audit support functions related to risk-based, operational, compliance, financial, and information technology audits, and consulting projects for HMSA. Assist in the execution of audit programs and consulting
Research and Analysis: Research and respond to low to medium complexity internal and external inquires. Is proficient at utilizing a variety of resources including but not limited to on-line information files and databases, Medicare/other plan guidelines,
Responsible for analysis, design, development, integration, maintenance and support of applications. Responsibilities include, but may not be limited to, the following: Leads and/or participates in the project planning process with clients, business analysts and team members.