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Network Prov Contract Implem Anl Assoc

Company: Blue Cross and Blue Shield Association
Location: Saint Paul
Posted on: November 24, 2022

Job Description:

About Blue Cross

Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.9 million members. We're committed to reinventing health care to improve health for our members and the community. We hope you'll join us.

How Is This Role Important to Our Work?

This position coordinates aspects of standard and non-standard provider contracts for lines of business and provider networks including managed care, open access and point of service delivery systems. This position implements provider data per contractual agreements and ensures that provider data payment information is loaded into the appropriate claim payment agreements and tables in the source provider system that directs payment transaction processing. This position is also responsible for assisting, collecting and analyzing data, supports more senior level positions in carrying out projects. Provides documentation for projects. This position receives assistance/ direction from either management or principal(s) on the team.

A Day in the Life:

* Perform analysis, build, and maintain multiple tables in the Reimbursement system including claim payment tables and claim payment agreements.

* Set up and maintain provider networks, and perform network validation/testing, as needed.

* Serve as a knowledge expert around the setup and maintenance of provider network Information.

* Research and refine existing assumptions and procedures to present recommendation for change.

* Participate in design, development and maintenance of contracting projects.

* Research and responds to internal and external inquiries.

* Identify workflow and system changes that will enhance the management of provider data.

* Prepare reports and assist in research and analysis of data.

* Perform audits of the provider data to ensure data quality and accuracy.

* This position assists senior positions in collecting and analyzing data to support department workload and special projects, performing experience analyses or developing assumptions.

* Documents methods, procedures and results.

* Works with senior positions or management to understand and interpret the data to support projects and/or relevant data.

* This position receives assistance/ direction from either management, principal(s) or senior(s) on the team.

* And is able to work on multiple priorities, deadlines and has the ability to adapt to change.

Required Skills and Experiences:

* Bachelors degree in Business, Accounting, Finance, Economics or related field and 2 years provider related or analytical experience, or a minimum of 6 years of provider related experience in lieu of a degree.

* Microsoft Word and Excel experience.

* Proven ability to work in a team environment, assisting co-workers and achieving team goals.

* Excellent organizational skills with the ability to multi-task.

* Demonstrated knowledge of provider reimbursement and payment methodologies.

* Demonstrated analytical and problem solving skills.

* Proven ability to manage multiple projects.

* Excellent verbal and written communications skills.

Role Designation:


Role designation definition: Teleworking is working full time remote. Hybrid is a combination of working onsite and remotely. Onsite is full-time onsite.

Make a difference

Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, gender expression, or any other legally protected characteristic.

Reasonable Accommodation for Job Seekers with a Disability: If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to

All roles require a high school diploma (or equivalency) and legal authorization to work in the U.S.

Blue Cross - and Blue Shield - of Minnesota and Blue Plus - are nonprofit independent licensees of the Blue Cross and Blue Shield Association.

Keywords: Blue Cross and Blue Shield Association, St. Paul , Network Prov Contract Implem Anl Assoc, Other , Saint Paul, Minnesota

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