Event Planning and Production Manager - 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.

PURPOSE OF THE JOBOrder, retrieve, match, research and process medical records received for both pre-payment and post- payment reviews for claims with strong emphasis on confidentiality and PHI.

Also responsible for updating computer systems.
QUALIFICATIONSREQUIRED QUALIFICATIONS1. Required Work Experience2 years of general correspondence experience2. Required EducationHigh-School Diploma or GED in general field of study3. Required LicensesN/A4. Required CertificationsN/APREFERRED QUALIFICATIONS1.

Preferred Work Experience1 year of experience in medical or health insurance field1 year of experience using Claims Processing system1 year of experience using proprietary Blue systems1 year of telephone experience2.

Preferred EducationN/A3. Preferred LicensesN/A4. Preferred CertificationsN/AESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIESMaintain productivity and accuracy requirements.
Order medical records for a variety of lines of business (local, Blue Card, FEP). Receive and research all medical records received to match to appropriate file for processing.
Prescreen medical records to determine if necessary information received.
Provide back up review aging report for open contacts as directed to ensure timeliness standards are met.
Responsible for researching and responding to inquiries.
Provides training and mentoring to staff.
Participate on special teams and projects as assigned by management.

Perform focused quality samplingCreate job aids and maintains desk level procedures as neededRequest medical records with special attention to confidentiality, PHI, adhering to corporate standards, State and Federal regulations and mandates.

Process letter files, reviewing for accuracy and sorting to prepare for mailing.
Request medical records for claims. Ensure requests are sent to appropriate Blue Plans.
Research error reportsIdentify and perform research of medical records and other correspondence received in the department.

Perform system location moves of pending claimsMonitor systems to retrieve medical recordsRespond to inquires from other Blue Plans related to medical record request questions adhering to strict response time required by the BCBS Association.

Retrieve and research phone messages and respond or direct the calls to the appropriate area for resolution. Set up contacts in the system for re-directed calls.
Monitor, clipboard and process faxes received for researchThe 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.
COMPETENCIESREQUIRED COMPETENCIES1.

Required Job SkillsIntermediate skill using office equipment including fax machines, scanner, and telephonesBasic PC proficiencyBasic skill in word processing, spreadsheet and database software2.

Required Professional CompetenciesMaintain confidentiality and privacyPerform investigative and analytical researchEstablish and maintain working relationships in a collaborative team environmentFollow and accept instruction and direction3.

Required Leadership Experience and CompetenciesN/APREFERRED COMPETENCIES1.

Preferred Job SkillsAdvanced skill using office equipment including fax machines, scanner, and telephonesAdvanced PC proficiencyAdvanced skill in word processing, spreadsheet and database software2.

Preferred Professional CompetenciesHandling of medical records and correspondenceClaims Processing and imaging systems3.

Preferred Leadership Experience and CompetenciesN/AOur CommitmentAZ 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.#J-18808-Ljbffr