Provider Network File Technician I - Phoenix, United States - Blue Cross Blue Shield of Arizona

Description

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.

This position requires work and residency to be performed within the state of Arizona.

Purpose of the job

Responsible for updating, maintaining and researching a variety of provider file information in multiple systems

REQUIRED QUALIFICATIONS

Required Work Experience

• 1 year of experience in general business field (level 1)
• 3 years of experience in general business field (level 2)
• 5 years of experience in general business field (levels 3 and 4)

Required Education

• High-School Diploma or GED in general field of study

Required Licenses

• N/A

Required Certifications

• N/A

PREFERRED QUALIFICATIONS
Preferred Work Experience

• 2 year(s) of experience in health insurance field

Preferred Education

• Associate's Degree in general field of study

Preferred Licenses

• N/A

Preferred Certifications

• N/A

ESSENTIAL job functions AND RESPONSIBILITIES

• Responsible for updating and maintaining the applicable provider file database(s) with documentation submitted.
• Responsible for provider contract file research and to recommend appropriate actions and/or maintenance.
• Responsible for researching and resolving provider file claims edits.
• Analyze reports for any data corrections and processes for the Association.
• Responsible for the review of the provider files for Quality Control.
• Each progressive level includes the ability to perform the essential functions of any lower levels.
• The position requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
• Perform all other duties as assigned.

competencies

REQUIRED COMPETENCIES

Required Job Skills

• Intermediate PC proficiency (Applies to All Levels)
• Intermediate skill in use of office equipment, including copiers, fax machines, scanners and telephones (Applies to All Levels)
• Intermediate level skill in word processing, spreadsheet and database software (Applies to All Levels)

Required Professional Competencies

• Maintain confidentiality and privacy (Applies to All Levels)
• Ability to interpret and translate policies, procedures and guidelines (Applies to All Levels)
• Ability to follow and accept instruction and direction (Applies to All Levels)
• Establish and maintain working relationships in a collaborative team enviroment (Applies to All Levels)
• Ability to navigate, gather, input and maintain data records in multiple system applications with applicable accuracy (Applies to All Levels)
• Ability to work independently (Applies to Levels
• Ability to problem solve (Applies to Levels
• Ability to provide fair and accurate quality reviews (Applies to Levels 3 & 4)
• Ability to handle projects with minimal supervision (Applies to Levels 3 & 4)
• Ability to handle high volumes of work with additional responsibility for cross functional duties (Applies to Level 4)

Required Leadership Experience and Competencies

• Ability to made decisions related to provider file processes & explain information clearly. (Applies to Levels 3 & 4)
• Ability to train, mentor and guide co-workers. (Applies to Levels 3 & 4)
• Ability to distribute work to lower levels (Applies to Level 4)
• Ability to handle escalated/expedited issues to resolution (Applies to Level 4)
• Ability to interpret and make decisions based on available reporting (Applies to Level 4)
• Ability to cover for Management when needed & represent the department (Applies to Level 4)

PREFERRED COMPETENCIES

Preferred Job Skills

• N/A

Preferred Professional Competencies

• N/A

Preferred Leadership Experience and Competencies

• N/A

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Our Commitment

AZ Blue does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.

Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see If interested in this position, please apply.