We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally and serve our local communities. We invite you to apply for a career with Blue Cross.

　　Please note that effective Jan. 4, 2022, Blue Cross and Blue Shield of Louisiana implemented a policy requiring any employee who enters any of our offices or who interacts in person with anyone for company business purposes to be fully vaccinated for COVID 19, unless legally entitled to a reasonable accommodation related to religious or medical exemptions. At this time, that policy is suspended and vaccination is not required to enter our facilities. Please note this is subject to change at any point in time to ensure compliance with company policy or government mandates and certain client facing roles may have separate protocols.

　　Residency in or relocation to Louisiana is preferred for all positions.

　　POSITION PURPOSE

　　As a member of Blue Cross Blue Shield of Louisiana’s Provider Data Management transformation team, this position is responsible for leading daily operations, assisting Provider Information Specialists with prioritizing an organizing their work as well as with handling complex provider file, provider contracts, and credentialing cases in the unit that require special expertise.

　　NATURE AND SCOPE

　　Manages People

　　This job reports to: Departmental Leadership

　　Necessary Contacts: In order to effectively fulfill this position, the incumbent must be in contact with:Management and non-management personnel in all operational areas of the company, providers, BCA, Accounting, Medical Management, Legal, Marketing, Provider Contracting, Provider Services, other Plan personnel, Licensing Organizations and other Health Care organizations.

　　QUALIFICATIONS

　　Education

　　Bachelor's degree in business is r required

　　Four years of related experience can be used in lieu of a Bachelor’s degree.

　　Work Experience

　　3 years of experience in health insurance claims, credentialing, and/or provider data management with a focus in the area of customer interaction is required.

　　2 years of demonstrated leadership experience is required. This experience can run concurrently with the three years of insurance, credentialing and/or provider data management experience.

　　Demonstrated research experience, which includes data management, data analysis and interpretation skills, preferably in the healthcare industry is required.

　　Skills and Abilities

　　Knowledge of Facets and claims strongly preferred.

　　Strong organizational, management, and communication skills are required.

　　Ability to make decisions, prioritize, find solutions, and work independently required.

　　Must have excellent interpersonal, oral, and written communications and presentation skills to effectively reach all levels of employees.

　　Critical thinking and the ability to question and challenge the status quo required.

　　Ability to multitask in a fast-paced production environment is required.

　　Ability to take accountability for the work performed is required.

　　Licenses and Certifications

　　None RequiredACCOUNTABILITIES AND ESSENTIAL FUNCTIONS

　　Manages staff level positions by administering all HR functions, including but not limited to, hiring, terminating, conducting performance reviews, managing work schedules, assigning and directing workload, training and developing staff, and coaching to help ensuring departmental, divisional, and/or corporate goals are obtained.

　　Supervises the Provider Data Operations team to ensure that they are correctly obtaining, verifying, monitoring, and documenting the setup of provider records.

　　Ensures that the provider’s information in the database is setup in accordance with the department’s policies and procedures.

　　Handles complex issues that require special expertise including coordinating how to handle operational and procedural issues with staff and management to ensure appropriate processing of provider information, including, but not limited to, claims issues, product configuration issues, and provider escalations.

　　Performs unit project management, including, but not limited to, task prioritization, system enhancements, work distribution, complex internal and/or external customer calls, and correspondence.

　　Serves as a subject matter expert and ensure the team receives appropriate education and instructions on Unit policies and procedures specific to Credentialing and Provider Data Management.

　　Maintains knowledge of all rules and regulations including BCBSA, CMS, NCQA, URAC, State of Louisiana, and Federal.

　　Partner with the Provider Data Management and Credentialing Leadership team to implement the departmental Strategic Plan.

　　Accountable for complying with all laws and regulations associated with duties and responsibilities.

　　Additional Accountabilities and Essential Functions

　　The Physical Demands described here are representative of those that must be met by an employee to successfully perform the Accountabilities and Essential Functions of the job. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions

　　Perform other job-related duties as assigned, within your scope of responsibilities.

　　Job duties are performed in a normal and clean office environment with normal noise levels.

　　Work is predominately done while standing or sitting.

　　The ability to comprehend, document, calculate, visualize, and analyze are required.

　　#LI_MS1

　　An Equal Opportunity Employer

　　All BCBSLA EMPLOYEES please apply through Workday Careers.

　　PLEASE USE A WEB BROWSER OTHER THAN INTERNET EXPLORER IF YOU ENCOUNTER ISSUES (CHROME, FIREFOX, SAFARI)

　　Additional Information

　　Please be sure to monitor your email frequently for communications you may receive during the recruiting process. Due to the high volume of applications we receive, only those most qualified will be contacted. To monitor the status of your application, please visit the "My Applications" section in the Candidate Home section of your Workday account.

　　If you are an individual with a disability and require a reasonable accommodation to complete an application, please contact [email protected] for assistance.

　　In support of our mission to improve the health and lives of Louisianians, Blue Cross encourages the good health of its employees and visitors. We want to ensure that our employees have a work environment that will optimize personal health and well-being. Due to the acknowledged hazards from exposure to environmental tobacco smoke, and in order to promote good health, our company properties are smoke and tobacco free.

　　Blue Cross and Blue Shield of Louisiana performs background and pre-employment drug screening after an offer has been extended and prior to hire for all positions. As part of this process records may be verified and information checked with agencies including but not limited to the Social Security Administration, criminal courts, federal, state, and county repositories of criminal records, Department of Motor Vehicles and credit bureaus. Pursuant with sec 1033 of the Violent Crime Control and Law Enforcement Act of 1994, individuals who have been convicted of a felony crime involving dishonesty or breach of trust are prohibited from working in the insurance industry unless they obtain written consent from their state insurance commissioner.

　　Additionally, Blue Cross and Blue Shield of Louisiana is a Drug Free Workplace. A pre-employment drug screen will be required and any offer is contingent upon satisfactory drug testing results.

　　JOB CATEGORY: Insurance