at Blue Cross of Idaho in Meridian, Idaho, United States
Job Description
Our InterPlan Consultant cultivates positive relationships with BCBSA (Blue Cross Blue Shield Association), Dun & Bradstreet (D&B), and Consortium Health Plans (CHP). This role involves partnering with other Blue Plans on escalations and day-to-day issues, including fact-finding activities.This role has preference for flexible hybrid location (onsite Meridian Idaho campus, and work-from-home); there may be opportunity fully remote work within a mutually acceptable location. #LI-Remote; #LI-Hybrid
Experience: 3/+ years' business analyst or similar analyst support experience in a related field within health insurance
Education: Bachelor's Degree or equivalent work experience (Two years' relevant work experience is equivalent to one-year college)
As Consultant, your day may look like:
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Relationship Management: Support the cultivation of positive relationships with BCBSA and Consortium Health Plans (CHP). Assist in acting as the liaison between BCI and BCBSA by building collaborative relationships internally and with BCBSA.
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Issue Resolution: Collaborate with other Blue Plans on escalations and day-to-day issues, including fact-finding activities. Assist in negotiating financial arrangements with Blue Plans on Par/Host and Control/Home business.
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Compliance and Reporting: Manage cede/Consent and Participation Requests. Monitor compliance with Association mandates and policies. Assist in managing BCBSA quarterly IPPER reporting. Support the development, execution, and monitoring of BCBSA Action Plans in areas of non-compliance.
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Strategic Initiatives: Assist in driving forward the BCBSA Strategic Roadmap and socializing it within BCI as appropriate. Support the internal BCI Governance Process for BCBSA initiatives. Participate in multiple BCBSA workgroups to drive future strategy, mandates, and policies.
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Training and Development: Support the use of mandatory InterPlan Training Modules. Assist in developing BlueCard training materials and presenting them to various departments to ensure understanding and compliance with BCBSA rules, policies, and procedures. Maintain and update existing training documentation for BlueHPN Business Owner.
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Data and Analysis: Provide disruption/GeoAccess review and analysis. Assist in providing Discount and Fee projections on multi-state accounts, providing Underwriting with the data needed to accurately project aggregated discounts and InterPlan Fees. Actively use and train others on available Consortium tools, including Cost Reports, UDS, Network Compare, Market Navigator, and Claims Repricings.
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Project Management: Support the implementation activities and ensure milestones are met for Clinical Data Exchange (CDE), Enhanced Data for Account Reporting (EDAR), ITS SaaS, Real-time Messaging (RTM). Actively engage in the testing of new portals/processes with BCBSA.
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Meeting Participation: Attend BCBSA InterPlan Executive meetings. Actively participate in Consolidated Appropriations Act (CAA) meetings, including monitoring and updating associated milestones. Weekly monitoring of BCBSA SurveySource, ensuring BCI is meeting survey deadlines and reaching out to those who appear they may be at risk of non-compliance.
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Collaboration: Brief leadership, as appropriate, on upcoming BCBSA meetings, providing documentation, and viewpoints. Partner with Plan InterPlan Executives on key issues, including best practices, high-level escalations, and policy. Collaborate with key BCI stakeholders to ensure organizational alignment to BCBSA policy.
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Additional Responsibilities: Maintain Control/Home Plan Profile and review and approve Par/Host Plan Profile requests. Maintain Out of Area Provider Termination file and provide timely updates as to the status of those terminations. Create new tools as needed to aid Sales in identifying members located within a BlueHPN Service Area. Review and approve Value-Based Programs PAMPM attributions for payment by Finance.
As of the date of this posting, a good faith estimate of the current pay range is: $58,727 - $82,219. The position is eligible for an annual incentive bonus (variable depending on company and employee performance). The pay range for this position takes into account a wide range of factors including, but not limited to, specific competencies, relevant education, qualifications, certifications, relevant experience, skills, seniority, performance, shift, travel requirements, internal equity, geography, business or organizational needs, and alignment with market data. At Blue Cross of Idaho, it is not typical for an individual to be hired at or near the top range for the position. Compensation decisions are dependent on factors and circumstances at the time of offer.
We offer a robust package of benefits including paid time off, paid holidays, community service and self-care days, medical/dental/vision/pharmacy insurance, 401(k) matching and non-contributory plan, life insurance, short and long term disability, education reimbursement, employee assistance plan (EAP), adoption assistance program and paid family leave program.
We will adhere to all relevant state and local laws concerning employee leave benefits, in line with our plans and policies.
Reasonable accommodations
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed above are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. To view full details and how to apply, please login or create a Job Seeker account
