Job Description |
Provider Solutions - Specialist IIIa - 2597
The work of a Specialist IIIa is guided by practices, procedures, precedents or well-defined policy and/or supervisory review. Incumbents determine their own priorities and may deviate from established procedures and practices as long as the end results meet standards of acceptability.
Job duties include but are not limited to the following:
• Obtains and analyzes data in order to determine root causes of internal and external
• Devises or modifies procedures to solve complex problems. Considers computer
equipment capacity and limitations, operating time, business systems, industry
requirements form of desired results and user need.
• Coordinates the completion of standard and ad hoc reporting.
• Analyzes business and user needs; documents requirements, translates into
functional specifications and manages changes to specifications. Serves as liaison
into IT factories. Negotiates agreements and commitments between business units
• Ensures the appropriate planning, preparation and execution of testing activities is
• Develops, creates, presents and facilitates presentations for a variety of audiences.
• Monitors and executes project and/or production support activities. May lead small to
• Guides and advises less experienced Analysts.
• Assists in business process redesign and documentation as needed.
• Moderate to heavy keying required.
• Bachelor’s degree or equivalent work experience
• 4+ years’ of related work experience.
• Knowledge of Network operation functions
• Knowledge of Project management principles
• Knowledge of SQL and SAS.
• Experience in claims adjudication processes and claim processing systems
• Knowledge of non-claims issues such as remittance advice, eligibility, benefits,
authorizations and referrals
Business Specific Criteria (preferred skills):
• Knowledge of technological trends.
• Strong analytical skills as demonstrated through successful identification and
resolution of provider pricing and business process issues based on root cause
• Knowledge of Availity Self-Service tools
• Knowledge of HIPPA requirements, policies, processes and transactions.
• Knowledge of change management principles.
• Experience with PC and standard office software, including Word, Excel and
PowerPoint.MS Office applications.
Primary Location Jacksonville
Other Locations Lake Mary, Miami, Tampa
Organization Blue Cross Blue Shield of Fla
Posting Deadline Mar 1, 2013, 11:59:59 PM
Blue Cross Blue Shield of Florida - 16 months ago
Your Health Solutions Company
We’re here for the people of Florida with every aspect of their health and wellness—from the...