Description
Temporary Employees: Are not eligible to apply for internal positions posted on the Intranet. Temporary employees are eligible to apply for any opportunities posted externally on the Internet at www.bcbsla.com once they have completed the minimum hours requirement in the temporary position.
Internal Applicants: Must meet the following two criteria in order to apply:
1. In their current job for 12 months
Where there is a formal classroom training program such as with customer service and claims processing jobs, the 12 month period will begin when the employee completes the training program and enters the job on a full time basis
2. In good standing(no disciplinary action and no rating of Needs Improvement on most recent review)
Applicants from within the department requesting the position are not required to meet the twelve-month criteria if the posted position is part of a natural career progression.
QUALIFICATIONS:
A bachelors degree required in health information management, medical record administration, statistics, accounting, actuarial science, mathematics, finance, or an analytically-oriented healthcare field required. An advanced degree in one of these fields is also required. Three years of related experience can be used in lieu of the advanced degree.
Minimum three years of experience in health informatics, health economics, medical coding, actuarial/underwriting, healthcare finance, or other related health plan reporting and analytics role required.
Preference is given to certification/pursuit of certification in medical coding, RHIA, RHIT, or actuarial exam credit.
Must have proficiency with commonly used database, spreadsheet, and word processing software (i.e. MS Access, MS Excel, MS Word) along with sufficient knowledge to select the appropriate database format and structure for the type of information to be captured and reported.
Strong knowledge of managed care processes required.
Must have working knowledge of provider operations and procedures.
Basic knowledge of medical coding, including grouper-derived codes (i.e. DRG, ETG, DCG) required.
Experience with reporting care management outcomes preferred.
Experience working with predictive models (i.e. ImpactPro, MCSource) and healthcare quality metrics (e.g. HEDIS) is highly desirable.
MAJOR ACCOUNTABILITIES:
Performs scientific and technical planning, analysis, reporting and methodological support that is relevant to medical management outcomes, which may include specific case management, utilization management, disease management, and/or medical policy initiatives.
Provides ongoing data analysis and recommends focus and direction of resources for decision makers and management that is relevant to the health care market; assists in problem solving, solution development, decision making, and strategic planning.
Translates business rules into analytical models and works as a liaison between technical owners and business owners to effectively communicate processes and results.
Participates in the acquisition, implementation, and enhancements of software and hardware to report Medical Management productivity and outcomes.
Participates and assists in the development of client reports as they relate to medical management and predictive modeling data; participates and assists in the ongoing development of an online client reporting mechanism. Prepares and provides decision support overviews, demonstrations, and presentations to a wide variety of internal and external audiences.
Serves as technical expert advisor and consultant to collaborating departments on corporate and cross-functional projects, reports, and activities.
Performs peer data quality reviews, validating data and process to ensure accuracy, completeness, and consistency of department output; recommends process improvements as necessary. Investigates existing national and regional data and performs descriptive and analytic studies using statistical techniques.
This position reports to the Vice President, Healthcare Informatics and Measurement.
This position is a grade 16. The starting minimum salary is $5,536.17/mo.
Details:
Job Id:
18873406
Annual Salary:
Position Type:
Education Level:
No Selection
Experience Level:
No selection
Posted:
2/6/2010 2:38:14 AM
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