Senior Health Care Analyst - Compliance and Provider Contracting Support

With more than 7,000 employees, we are the largest health insurance company in Michigan. We offer an exciting work environment with a diverse group of employees. Our goal is to make health insurance easier for our members. We want to transform the industry and become a resource that people can trust.

Southfield, MI

Blue Cross Blue Shield of Michigan

When you think of <a href="https://www.bcbsm.com/" target="_blank" rel="noopener noreferrer">Blue Cross Blue Shield of Michigan</a> for health insurance, you can know you&rsquo;re getting much more. We're a company founded on a tradition of affordable, quality health care for everyone, improving the present and investing in the future.&nbsp;<br /><br />We offer:<br />Plans for employers and individuals that meet today&rsquo;s needs, budgets and lifestyle<br />The largest network of doctors and hospitals in the state<br />Lower health care costs Higher quality health care<br />Award-winning diversity practices<br />Grants and programs that promote better health throughout Michigan<br /><strong><br />Mission:&nbsp;</strong>We commit to being our members&rsquo; trusted partner by providing affordable, innovative products that improve their care and health.<br /><br /><a href="http://www.bcbsm.com/index/about-us/our-company.html" target="_blank" rel="noopener noreferrer"><strong>Click here</strong></a> to learn more about our commitment to our Social Mission, view company updates and reviews, and view our awards &amp; accolades.<br /><br />For Application Timeline &amp; Selection Process:&nbsp;<a href="https://s3.amazonaws.com/data.vizirecruiter.com/Images/BCBSMCareers+-+Quick+Reference+Guide.pdf" target="_blank" rel="noopener noreferrer">Click Here</a>. Learn more about your options as an external candidate. <a href="https://ejko.fa.us2.oraclecloud.com/hcmUI/CandidateExperience/en/sites/CX_3/requisitions" target="_blank" title="BCBSM" rel="noopener noreferrer">Click here</a> to view open positions. http://www.bcbsm.com

keywords: planning,research,goals,develop,management,investigate,analysis,communication,maintenance,knowledge,compliance,degree,experience,communication,professional

Non-Manager

Competitive Total Compensation Package

Overview: <strong>Responsible for planning, organizing, directing, implementation, and leading department assignments.&nbsp; Position operates within broad objectives to ensure optimum utilization of manpower and budget.&nbsp; Research, compile and analyze appropriate and relevant data and make recommendations for operational improvements.</strong>
Responsibilities: <ul> <li>Leads in the research, analysis, identification and evaluation of data from assigned problems to evaluate existing and potential trends and issues.</li> <li>Possess and maintain an extensive comprehensive knowledge of BCBSM business, products, programs (including provider data, networks, etc.), corporate organizational structure (including functional responsibilities), and basic research principles/methodologies.</li> <li>Manage and monitor multiple projects simultaneously by establishing project plans and objectives to ensure goal attainment within defined parameters.</li> <li>Develop lines of communication to discuss/review results of analysis to management via reports/presentations and assist management in implementing programs that provide solutions.</li> <li>Investigate, review, recommend, communicate and implement solutions which identify problems/root cause of issues.</li> <li>Identify and resolve challenges in order to fulfill key corporate objectives and respond to the demand of change management and initiate actions needed to plan, organize and control team activities.</li> <li>Independently develop and plan, reports, papers and/or other materials in a clear and concise manner.</li> <li>Provide expertise and guidance to unit and corporate staff as required.</li> <li>Acts as liaison between corporate business areas and participates in group or committee discussions.</li> </ul>
Requirements: <strong>Qualifications</strong> <ul> <li>Bachelor's Degree in Business Administration, Economics, Health Care, Information Systems, Statistics or other related field is required.&nbsp; Master's Degree in related field preferred.</li> <li>Six (6) or more years experience in related experience, typically in two (2) subject areas (e.g. financial analysis, planning, health care economics, health care policy, statistical modeling, business decisions, analysis, or business management).</li> <li>Excellent analytical, planning, problem solving, verbal and written skills to communicate complex ideas.</li> <li>Excellent knowledge and use of existing software packages (PowerPoint, Excel, Word, etc.).</li> <li>Strong working knowledge of data languages such as SAS or SQL.</li> <li>Ability to work independently, within a team environment and communicate effectively with employees at all levels.</li> <li>Other related skills and/or abilities may be required to perform this job.</li> </ul> <p>Department Summary / Preferences:</p> <p>Preferences<br />Familiar with CMS (ACA and MA) and DIFS regulations, and NCQA standards, or the ability to locate and interpret<br />Preferably the requirements and standards as they pertain to provider contracting and network adequacy<br />Provider contracting experience a plus<br />Acquainted with provider quality programs preferred</p> <p>Responsibilities<br />Department compliance oversight including ensuring department activities meet all regulatory and accreditation requirements<br />Support the provider retrospective profiling (PRP) process Examples of responsibilities include:&nbsp;<br />&bull;Maintenance of provider contract language and department policies and procedures<br />&bull;Participation in workgroups such as Compliance Liaison Council, regulatory change implementation and new provider types &nbsp;<br />&bull;Facilitate preparation of required documentation for audits and accreditation reviews<br />&bull;Support strategy development to enhance the PRP process</p>