Quality Specialist
Our organization is looking for dynamic individuals who love to learn, thrive on innovation, and are open to exploring new ways to achieve our goals. If this describes you, we want to speak with you. You can help us achieve our vision to lead nationally in innovating equitable whole-person health.
The Quality Specialist has the responsibility of executing analytical skills used for reviewing provider set-up, maintenance, testing, and quality checking (QC) various facility reimbursement methodologies. The associate will quality-check Facility and Ancillary reimbursement to ensure accuracy within the claim processing system.
Tracks all tasks and deliverable dates and maintains all required documentation. Performs data analysis by executing queries and compares using Access. Maintains tracking of the QC for pricing requests within the Consolidated Dashboard.
Assist with review and clearing of provider workbaskets.
Communicates to management progress on assignments, including time estimates and system schedules. Performs other duties as assigned.
Qualifications:
· Bachelor's Degree in Computer Science, Business, or health-related field/ commensurate work experience is required
· 5 years of proven work experience in business unit necessary
· Aptitude for detail-oriented work. Strong analytical, technical, and problem-solving skills.
· Experience with the following systems:
· Consolidated Dashboard (CDB)
· Oscar Claims Web Application (OWCA)
· Corporate Provider Repository Mainframe System (CPR)
· TS02 Pricing Files
· Provider Profiles (HPRCPR)
· Highmark Mainframe (Oscar)
· Demonstrate effective communication during work group sessions and meetings.
· Strong understanding of Facility and Professional Provider data and reimbursement operations required.
· Advanced understanding of Microsoft Access, Excel, and Word.
· Demonstrated effective strong oral and written communication skills.
· The ability to work autonomously with little direction.
Hybrid:
Independence has implemented a “Hybrid” model which consists of Associates working in the office 3 days a week (Tuesday, Wednesday & Thursday) and remotely 2 days a week (Monday & Friday). This role is designated as a role that fits into the “Hybrid” model. While associates may work remotely on our designated remote days, the work must be performed in the Tri-State Area of Delaware, New Jersey, or Pennsylvania.
Independence Blue Cross is an Equal Opportunity and Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.
Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.
Diversity, Equity, and Inclusion
At Independence, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.
About Our Company
Serving more than 8 million people nationwide, including 2.5 million in southeastern Pennsylvania, Independence Health Group — together with its subsidiaries — is the leading health insurance organization in the Philadelphia region. Our mission to build healthier lives for you, your family, and your employees shapes our actions and decisions every day.
At Independence, we see each of our members as an individual, with unique needs and concerns. We’re dedicated to harnessing the very latest ideas and technologies to deliver access to care that meets those needs and surpasses your expectations. For more information about Independence access our website at www.ibx.com. We’re revolutionizing health care, and our focus is on you!
Equal Employment Opportunity
Independence Blue Cross is an Equal Opportunity and Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.
Agency Disclaimer
All resumes submitted directly to an Independence Blue Cross employee from a vendor via email, the Internet or in any other form without a valid written search agreement in place for this position from the Independence Blue Cross Family of Companies Human Resources Department will be deemed the sole property of Independence Blue Cross and the Independence Blue Cross Family of Companies. Please note that no fee will be paid in the event the candidate is hired by Independence Blue Cross or the Independence Blue Cross Family of Companies as a result of the referral or through means other than our established process.