Payment Integrity Quality Program Implementation Specialist I or II

Blue Cross of Idaho • Meridian, ID

22d

About The Position

Blue Cross of Idaho is seeking a Quality/Program Implementation Specialist to be responsible for the analysis, management and implementation of editing and auditing concepts and customizations. This person will collaborate with multiple internal business partners to find opportunities for continuous process improvements.

Requirements

• Level I: 2 years’ analytical, health industry, or relevant experience
• Level II: 4 years’ analytical, health industry, or relevant experience
• Bachelor’s Degree or equivalent work experience (Two years’ relevant work experience is equivalent to one-year college)

Responsibilities

• Monitor editing and auditing programs for trends and process improvement opportunities.
• Present issues, lead and/or participates in discussions and develop conclusions with internal and external professionals.
• Provide functional requirements working with software developers to find the best solution to meet various projects.
• Review contracts and policy language to ensure claims processing results match the intent of contract and policy terms.
• Prepare and present in-depth written technical assessment.
• Perform other duties and responsibilities as assigned.

Benefits

• paid time off
• paid holidays
• community service and self-care days
• medical/dental/vision/pharmacy insurance
• 401(k) matching and non-contributory plan
• life insurance
• short and long term disability
• education reimbursement
• employee assistance plan (EAP)
• adoption assistance program
• paid family leave program

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: Associate degree