What are the responsibilities and job description for the Quality Specialist position at Independence Blue Cross Careers?
Our organization is looking for dynamic individuals who love to learn, thrive on innovation, and are open to exploring new ways to achieve our goals. If this describes you, we want to speak with you. You can help us achieve our vision to lead nationally in innovating equitable whole-person health.
The Quality Specialist has the responsibility of executing analytical skills used for reviewing provider set-up, maintenance, testing, and quality checking (QC) various facility reimbursement methodologies. The associate will quality-check Facility and Ancillary reimbursement to ensure accuracy within the claim processing system.
Tracks all tasks and deliverable dates and maintains all required documentation. Performs data analysis by executing queries and compares using Access. Maintains tracking of the QC for pricing requests within the Consolidated Dashboard.
Assist with review and clearing of provider workbaskets.
Communicates to management progress on assignments, including time estimates and system schedules. Performs other duties as assigned.
Qualifications:
· Bachelor's Degree in Computer Science, Business, or health-related field/ commensurate work experience is required
· 5 years of proven work experience in business unit necessary
· Aptitude for detail-oriented work. Strong analytical, technical, and problem-solving skills.
· Experience with the following systems:
· Consolidated Dashboard (CDB)
· Oscar Claims Web Application (OWCA)
· Corporate Provider Repository Mainframe System (CPR)
· TS02 Pricing Files
· Provider Profiles (HPRCPR)
· Highmark Mainframe (Oscar)
· Demonstrate effective communication during work group sessions and meetings.
· Strong understanding of Facility and Professional Provider data and reimbursement operations required.
· Advanced understanding of Microsoft Access, Excel, and Word.
· Demonstrated effective strong oral and written communication skills.
· The ability to work autonomously with little direction.
Hybrid:
Independence has implemented a “Hybrid” model which consists of Associates working in the office 3 days a week (Tuesday, Wednesday & Thursday) and remotely 2 days a week (Monday & Friday). This role is designated as a role that fits into the “Hybrid” model. While associates may work remotely on our designated remote days, the work must be performed in the Tri-State Area of Delaware, New Jersey, or Pennsylvania.
Independence Blue Cross is an Equal Opportunity and Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.
Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.
