CareFirst BlueCross BlueShield
Program Manager-PEX (Hybrid)
CareFirst BlueCross BlueShield, Baltimore, Maryland, United States, 21276
Resp & Qualifications
PURPOSE:
The Program Manager will serve as a point person to BCBSA for the Provider Engagement Exchange (PEX) and supports the Medicare and commercial programs. The position coordinates and implements activities supporting accurate and timely document management and retrieval efforts, and adherence to regulatory and project timelines. Medicare and commercial programs
ESSENTIAL FUNCTIONS:
Represent CareFirst in BCBS discussions and updates and collaborate with internal stakeholders to meet deliverables. Collaborates with internal stakeholders to manage medical record and gap closure requests. Develop process for managing PEX Home requests, including reporting, KPI measurement, and systemic changes. Ensure that the program adheres to regulatory requirements and quality standards.
Assumes a key role in the development of new processes and tracking systems to support best practice record keeping and document management procedures. Identifies process issues and contributes to the design of solutions. Proactively implements process improvements. Assists internal team and provider groups to troubleshoot any logistical or technical issues regarding record requests or retrieval. Manage the strategy and execution of the PEX program, ensuring alignment with organizational goals and objectives. Identify areas for process enhancement and implement best practices to optimize provider engagement and satisfaction.
Contacts provider offices with a high degree of professionalism and confidence to communicate expectations, charts required, etc. Establishes relationships with providers and ROI (Request of Information) vendors. Assists providers offices with the process of sending medical records. Educates, trains, provide support to providers staff on the different methods to send medical records. Analyzes and monitors progress of incoming correspondence including medical records to determine which organizations will need additional outreach. Identifies, investigates, and resolves issues related to incoming correspondence.
Conducts provider outreach and research to locate contact information of medical providers that may be practicing, retired, or otherwise relocated. Updates and maintains the Provider Database. Communicates professionally with medical facilities, third party vendors, and Company stakeholders.
Develops tracking and monitoring methods for medical record requests. Manages and maintains medical records repository. Ensures accuracy, timeliness of record uploads, compliance with processes to protect PHI, and effective tracking of records and record requests. Performs processing tasks such as moving documents as appropriate to the repository or vendor platform. Retrieval of medical records via fax, mail, remote electronic medical record access or onsite visits at the provider location. Use computer systems and applications for data entry, edits, and information retrieval.
SUPERVISORY RESPONSIBILITY: Leads a team utilizing a matrix management system, QUALIFICATIONS: Education Level:
Bachelor's Degree in Business Management or related field OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience. Experience
: 8 years project management or program management experience. Preferred Qualifications
: Master's Degree
Project Management Professional Certification (PMP)
Knowledge, Skills and Abilities (KSAs) Experience in using Microsoft Office (Excel, Word, Power Point, etc.) and Adobe Pro and demonstrated ability to learn/adapt to computer-based tracking and data collection tools.
Experience working with technical teams to launch programs/processes.
Ability to effectively communicate (oral and written) and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
Strong organizational skills, ability to prioritize responsibilities with attention to detail.
Self-motivated, able to take initiative, and work independently with minimal oversight to meet timelines, strong follow-through skills and a solutions-oriented attitude.
Ability to work with multiple system applications simultaneously.
Highly developed interpersonal skills.
Ability to synthesize large complex data and analysis into clear, concise, executive level presentations that allow for rapid grasp of business problem or opportunity and understanding of feasible solutions.
Effective understanding of how functions integrate within the division and the strategic concept behind the corporate goals.
Ability to translate business needs as it relates to technology, systems, and vendor platforms.
Ability to identify and shepherd strategic opportunities that have a significant impact on the organization.
Ability to establish working relationships and influence/persuade across all levels of leadership including C-Suite.
Knowledge and discipline of Process Improvement.
Use of Microsoft Applications.
Licenses/Certifications
: Certified Project Management Professional (PMP)-PMI Preferred. Salary Range: $105,696 - $209,924 Salary Range Disclaimer The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements). Department Enterprise Medical Records Equal Employment Opportunity CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information. Where To Apply Please visit our website to apply: www.carefirst.com/careers Federal Disc/Physical Demand Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on health care programs. PHYSICAL DEMANDS: The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted. Sponsorship in US Must be eligible to work in the U.S. without Sponsorship. #LI-SS1 REQNUMBER: 21190 #J-18808-Ljbffr
Assumes a key role in the development of new processes and tracking systems to support best practice record keeping and document management procedures. Identifies process issues and contributes to the design of solutions. Proactively implements process improvements. Assists internal team and provider groups to troubleshoot any logistical or technical issues regarding record requests or retrieval. Manage the strategy and execution of the PEX program, ensuring alignment with organizational goals and objectives. Identify areas for process enhancement and implement best practices to optimize provider engagement and satisfaction.
Contacts provider offices with a high degree of professionalism and confidence to communicate expectations, charts required, etc. Establishes relationships with providers and ROI (Request of Information) vendors. Assists providers offices with the process of sending medical records. Educates, trains, provide support to providers staff on the different methods to send medical records. Analyzes and monitors progress of incoming correspondence including medical records to determine which organizations will need additional outreach. Identifies, investigates, and resolves issues related to incoming correspondence.
Conducts provider outreach and research to locate contact information of medical providers that may be practicing, retired, or otherwise relocated. Updates and maintains the Provider Database. Communicates professionally with medical facilities, third party vendors, and Company stakeholders.
Develops tracking and monitoring methods for medical record requests. Manages and maintains medical records repository. Ensures accuracy, timeliness of record uploads, compliance with processes to protect PHI, and effective tracking of records and record requests. Performs processing tasks such as moving documents as appropriate to the repository or vendor platform. Retrieval of medical records via fax, mail, remote electronic medical record access or onsite visits at the provider location. Use computer systems and applications for data entry, edits, and information retrieval.
SUPERVISORY RESPONSIBILITY: Leads a team utilizing a matrix management system, QUALIFICATIONS: Education Level:
Bachelor's Degree in Business Management or related field OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience. Experience
: 8 years project management or program management experience. Preferred Qualifications
: Master's Degree
Project Management Professional Certification (PMP)
Knowledge, Skills and Abilities (KSAs) Experience in using Microsoft Office (Excel, Word, Power Point, etc.) and Adobe Pro and demonstrated ability to learn/adapt to computer-based tracking and data collection tools.
Experience working with technical teams to launch programs/processes.
Ability to effectively communicate (oral and written) and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.
Strong organizational skills, ability to prioritize responsibilities with attention to detail.
Self-motivated, able to take initiative, and work independently with minimal oversight to meet timelines, strong follow-through skills and a solutions-oriented attitude.
Ability to work with multiple system applications simultaneously.
Highly developed interpersonal skills.
Ability to synthesize large complex data and analysis into clear, concise, executive level presentations that allow for rapid grasp of business problem or opportunity and understanding of feasible solutions.
Effective understanding of how functions integrate within the division and the strategic concept behind the corporate goals.
Ability to translate business needs as it relates to technology, systems, and vendor platforms.
Ability to identify and shepherd strategic opportunities that have a significant impact on the organization.
Ability to establish working relationships and influence/persuade across all levels of leadership including C-Suite.
Knowledge and discipline of Process Improvement.
Use of Microsoft Applications.
Licenses/Certifications
: Certified Project Management Professional (PMP)-PMI Preferred. Salary Range: $105,696 - $209,924 Salary Range Disclaimer The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements). Department Enterprise Medical Records Equal Employment Opportunity CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information. Where To Apply Please visit our website to apply: www.carefirst.com/careers Federal Disc/Physical Demand Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on health care programs. PHYSICAL DEMANDS: The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted. Sponsorship in US Must be eligible to work in the U.S. without Sponsorship. #LI-SS1 REQNUMBER: 21190 #J-18808-Ljbffr