Mgr, Out of Network Open Negotiation & Arbitration - HYBRID

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy.AZ Blue offersa variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.

At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements:

• Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week

• Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week

• Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per month

• Onsite: daily onsite requirement based on the essential functions of the job

• Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building

Please note that onsite requirements may change in the future, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per week.

This position is hybrid within the state of AZ only.This hybrid work opportunity requires residency, and work to be performed, within the State of Arizona.

PURPOSE OF THE JOB

The Manager leads the organization's management response to the NSA including Managing provider inquiries, open negotiation requests, disputes, and arbitrations. This position is responsible for ensuring timely and accurate arbitration submissions, responding to federal inquiries, and making recommendations to leadership regarding final offer amounts, claims disputes, and contracting strategy.

QUALIFICATIONS

REQUIRED QUALIFICATIONS

Required Work Experience

• 4 years of experience in a network related role, such as contracting or provider services
• 3 years of experience utilizing financial models and analysis.
• 3 years of experience in claims and health insurance systems and processes.

Required Education

• High-School Diploma or GED in general field of study

Required Licenses

• N/A

Required Certifications

• N/A

PREFERRED QUALIFICATIONS

Preferred Work Experience

• 5 years of experience in managed care, provider relations or provider contracting field

Preferred Education

• Bachelor's degree in Healthcare Administration or Business Administration or related field or requisite professional experience

Preferred Licenses

• N/A

Preferred Certifications

• N/A

ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES

• Oversee daily NSA activities, provide direction and training to staff responding to NSA related activities.
• Use pertinent data and facts to identify and solve a range of issues and to identify opportunities.
• Perform claims research, respond to arbitrator inquiries related to NSA, provider inquiries and internal claims teams.
• Prioritize and organize your own work and work of the NSA staff to meet deadlines.
• Participate in development and maintenance of NSA policies and procedures, desktops, and workflows.
• Review and respond to arbitration requests.
• Define, initiate, and direct analysis of offers and claims to assess appropriate action related to NSA.
• This position includes direct supervisory capacity over a team of ten (10) or more staff, consisting of full-time employees and contract workers.
• Perform all other duties as assigned.
• The position has an onsite expectation of 2 days per week and requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.

COMPETENCIES

REQUIRED COMPETENCIES

Required Job Skills

• In-depth knowledge and experience of the NSA, CMS rules and regulations related to the NSA and internal data needs to effectively manage the organization's response to NSA and implementation of the law.
• Provide recommendations to leadership and staff on final offers, contracting status and process improvements.

• Intermediate level of knowledge of claims processing systems including Blue Squared and internal guidelines.
• Ability to manage multiple deadlines and system processes simultaneously.

Required Professional Competencies

• Excellent verbal and written communication skills; ability to speak clearly and concisely, conveying complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others.
• Strong interpersonal skills, establishing rapport and working well with others.
• Strong customer service skills.

Required Leadership Experience and Competencies

• N/A

PREFERRED COMPETENCIES

Preferred Job Skills

• Working knowledge of common software solutions including Excel, SharePoint, etc.

Preferred Professional Competencies

• N/A

Preferred Leadership Experience and Competencies

• N/A

Our Commitment

AZ Blue does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.

Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply.