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 us.
Residency in or relocation to Louisiana is preferred for all positions.
POSITION PURPOSEOversees the daily operations of the unit for assigned staff in the unit. Serves as a leader and back-up for assigned staff in the unit. Coordinates workload and provides assistance on complex cases that require special expertise in the unit so that they are resolved in a timely manner. Complies with all laws and regulations associated with duties and responsibilities.
NATURE AND SCOPE- Manages People
- This role directly manages 12 workers
- This role directly manages these jobs: PROVIDER DISPUTES SPECIALIST
- This role reports to this job: MANAGER, Medical Coding
- Necessary Contacts: In order to effectively fulfill this position, this position must be in contact with:
Various internal and external entities including, but not limited to, all levels of BCBSLA personnel, attorneys, group leaders, members, hospitals, physician offices, and DOI.
QUALIFICATIONSEducation- High School Diploma or equivalent required
- Bachelor's degree in a related field preferred
Work Experience- 5 years of insurance experience to include experience in disputes, appeals and grievances, adjustments and customer service and one year of demonstrated leadership experience. Experience can run concurrently required
- 2 years of leadership experience preferred.
Skills and Abilities- Must be able to read and interpret benefits for all lines of business.
- Must be able to read and interpret all provider contracts and manuals.
- Must be knowledgeable and able to provide technical guidance on claims processing and complex appeals functions and cases.
- Demonstrated knowledge of accreditation guidelines, state laws, and relevant PC software which includes Facets, Epic, MS Word, Query Tools, Excel and Outlook is preferred
- Requires attention to detail and excellent record-keeping skills. Must demonstrate the ability to work in a rapidly paced and ever-changing environment.
- Able to make decisions, prioritize, find solutions and work independently.
- Strong analytical and organizational ability and verbal and written communication skills are required.
- Must have excellent time-management and interpersonal skills to respond to numerous inquiries in a diplomatic and timely manner.
- Presentation and public speaking skills are required.
Licenses and Certifications ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS- Administers all HR functions, including but not limited to, hiring, terminating, conducting performance reviews, setting performance standards, approving work schedules, assigning and directing workload, training and developing staff, coaching, etc. to ensure team goals are met.
- Serves as the subject matter expert to ensure accurate and timely handling of all cases. Maintains thorough knowledge of all contract types, changes to recent laws and regulations, computer systems and claims policies and procedures to ensure consistency in processes and responses.
- Motivates, coaches, audits and trains staff by answering questions, providing technical assistance, reviewing case files and letters to ensure deadlines are met and compliance with company policy, laws and regulations are maintained.
- Identifies and reports weekly trends in production, inventory levels, and performance statistics.
- Interfaces with providers to promote education, consistency and satisfaction.
- Coordinates the daily workflow to ensure compliance with established internal and external policies and procedures to ensure timeframes are satisfied.
- Assists in the development of departmental policies and procedures. Makes complex decisions involving consumer and provider contracts to ensure compliance with state and federal regulations, accreditation and business practices.
- Familiar with the many differences in the Self Funded block of business and our fiduciary responsibility and requirements.
Additional Accountabilities and Essential FunctionsThe 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.
An Equal Opportunity Employer
All internal 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 recruiting@bcbsla.com for assistance.
In support of our mission to improve the health and lives of Louisianians, we encourage 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.
We perform 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, we are a Drug Free Workplace. A pre-employment drug screen will be required and any offer is contingent upon satisfactory drug testing results.
