Blue Cross Blue Shield of Alabama
Provider Network Consultant II - Provider Business Services
Blue Cross Blue Shield of Alabama, Birmingham, Alabama, United States, 35275
Overview
The Provider Network Consultant II in Provider Business Services leverages data analytics to support Provider Engagement Support operations and corporate strategies. This role is responsible for analyzing healthcare data related to networks, claims, utilization, EDI transactions, clinical data, credentialing, provider engagement, and cost management, as well as activities supporting the development and implementation of corporate initiatives.
Primary Responsibilities Key responsibilities include performing analytical design, data gathering, and in-depth analysis to identify trends and opportunities for improvement in healthcare utilization and quality. The position creates and publishes reports and dashboards, along with ad hoc analyses, to fulfill corporate objectives and meet obligations to employer groups, providers, executives, and other internal stakeholders. Strong collaboration, organizational skills, and knowledge of provider contracts, clinical guidelines, and claims processes are essential to deliver actionable insights that strengthen provider relationships, support administrative efficiency, and enhance the quality and cost-effectiveness of care.
Summary of Qualifications
Bachelor's Degree
3 years of experience working in the healthcare industry
General knowledge of member and provider contract benefits, clinical guidelines, medical policy and claims processing for all lines business or equivalent healthcare related industry knowledge
Experience in a position communicating information orally and written
Experience in a position exercising independent judgment and decision making
Experience in a position resolving difficult and stressful situations
Experience in a position identifying and solving problems
Experience working with various Microsoft Office programs
Willingness to travel out of the office and overnight
Experience managing multiple projects with various priorities
Experience participating in initiatives to improve productivity, quality or efficiency of processes
Experience in a position using analytical skills
Experience or understanding of provider workflows and technologies
Experience understanding and interpreting medical policy and member benefits
Experience leading and controlling effective meetings, both internally and externally
Experience in building relationships and networking to obtain the trust of business owners, Information Technology (IT), and stakeholders
Experience in a position preparing correspondence, contracts, documents etc.
Familiarity with medical terminology
Exposure to claims processing procedures
Experience in a position organizing and prioritizing tasks
Experience with statistical reporting (e.g. Crystal Reports, Tableau, Excel, etc.) preferred
Experience in a position leading complex projects preferred
Experience in a position working independently under little or no supervision preferred
Minimum of three years of experience analyzing data
Demonstrated experience analyzing or reporting data sets using tools such as WinSQL, Toad, Crystal Reports, Excel, Tableau or PowerBI
Analytical and technical skills necessary to execute each phase of analysis including methodological design, data integration, and data visualization
Demonstrated successful organizational skills, creativity, problem-solving skills, and managing multiple priorities
Thorough knowledge of how a company in the healthcare industry operates and its business relationships, and how these relationships directly impact analytical processes
Strong attention to detail with excellent organizational skills
Working knowledge of Blue Cross and Blue Shield of Alabama Corporate data warehouse or production database
NOTE: Can be filled at a higher level based on experience
Work Location The work schedule for this position will be hybrid (onsite/remote). Business areas reserve the right to require associates to return to the office as needed, based on performance or other business considerations. A hybrid work schedule is subject to amendment or termination at any time by the Company.
Terms and Agreements By submitting a job application, I attest that all information to the best of my knowledge is true and accurate. Furthermore, I understand that any information provided by me throughout the job application process is subject to verification including, but not limited to work experience, education, assessment (test) and interviews. Blue Cross and Blue Shield of Alabama is an independent licensee of the Blue Cross and Blue Shield Association and does not discriminate in hiring or employment on the basis of race, color, religion, creed, sex, sexual orientation, gender identity, national origin, age, disability, genetics, status as a disabled or protected veteran, or citizenship status.
Realize Full Potential
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Primary Responsibilities Key responsibilities include performing analytical design, data gathering, and in-depth analysis to identify trends and opportunities for improvement in healthcare utilization and quality. The position creates and publishes reports and dashboards, along with ad hoc analyses, to fulfill corporate objectives and meet obligations to employer groups, providers, executives, and other internal stakeholders. Strong collaboration, organizational skills, and knowledge of provider contracts, clinical guidelines, and claims processes are essential to deliver actionable insights that strengthen provider relationships, support administrative efficiency, and enhance the quality and cost-effectiveness of care.
Summary of Qualifications
Bachelor's Degree
3 years of experience working in the healthcare industry
General knowledge of member and provider contract benefits, clinical guidelines, medical policy and claims processing for all lines business or equivalent healthcare related industry knowledge
Experience in a position communicating information orally and written
Experience in a position exercising independent judgment and decision making
Experience in a position resolving difficult and stressful situations
Experience in a position identifying and solving problems
Experience working with various Microsoft Office programs
Willingness to travel out of the office and overnight
Experience managing multiple projects with various priorities
Experience participating in initiatives to improve productivity, quality or efficiency of processes
Experience in a position using analytical skills
Experience or understanding of provider workflows and technologies
Experience understanding and interpreting medical policy and member benefits
Experience leading and controlling effective meetings, both internally and externally
Experience in building relationships and networking to obtain the trust of business owners, Information Technology (IT), and stakeholders
Experience in a position preparing correspondence, contracts, documents etc.
Familiarity with medical terminology
Exposure to claims processing procedures
Experience in a position organizing and prioritizing tasks
Experience with statistical reporting (e.g. Crystal Reports, Tableau, Excel, etc.) preferred
Experience in a position leading complex projects preferred
Experience in a position working independently under little or no supervision preferred
Minimum of three years of experience analyzing data
Demonstrated experience analyzing or reporting data sets using tools such as WinSQL, Toad, Crystal Reports, Excel, Tableau or PowerBI
Analytical and technical skills necessary to execute each phase of analysis including methodological design, data integration, and data visualization
Demonstrated successful organizational skills, creativity, problem-solving skills, and managing multiple priorities
Thorough knowledge of how a company in the healthcare industry operates and its business relationships, and how these relationships directly impact analytical processes
Strong attention to detail with excellent organizational skills
Working knowledge of Blue Cross and Blue Shield of Alabama Corporate data warehouse or production database
NOTE: Can be filled at a higher level based on experience
Work Location The work schedule for this position will be hybrid (onsite/remote). Business areas reserve the right to require associates to return to the office as needed, based on performance or other business considerations. A hybrid work schedule is subject to amendment or termination at any time by the Company.
Terms and Agreements By submitting a job application, I attest that all information to the best of my knowledge is true and accurate. Furthermore, I understand that any information provided by me throughout the job application process is subject to verification including, but not limited to work experience, education, assessment (test) and interviews. Blue Cross and Blue Shield of Alabama is an independent licensee of the Blue Cross and Blue Shield Association and does not discriminate in hiring or employment on the basis of race, color, religion, creed, sex, sexual orientation, gender identity, national origin, age, disability, genetics, status as a disabled or protected veteran, or citizenship status.
Realize Full Potential
#J-18808-Ljbffr