Data & Reporting Specialist Job Vacancy in Independence Blue Cross Philadelphia, PA – Latest Jobs in Philadelphia, PA
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Company Name : Independence Blue Cross
Location : Philadelphia, PA
Position : Data & Reporting Specialist
Job Description : SummaryResponsible for ensuring that credentialing processes are compliant with both internal and external requirements. This includes conducting studies to identify issues, collecting and analyzing audit results, proposing solutions, supporting implementation of processes supporting automation, ensuring automated processes are working as designed, documenting business requirement, developing Corrective Action Plans, inventory projections, and working directly with the Credentialing leadership team to improve the overall production, and quality of the Credentialing process.AccountabilitiesReview and evaluate credentialing inventory to ensure timely processing and to identify any data issues affecting the process. Utilizing all available resources including but not limited to practitioner files, Provider database, Credentialing database, CAQH, and credentialing policies to identify process improvements. Consistently and accurately applies current policies and procedures in evaluating transactions. Support decisions with appropriate documentation and notification to the appropriate staff and areas affected.Evaluate data available in the credentialing database to identify problems in systems, process, and/or individual performance. Identifies differences between established standards and credentialing processing applications, policies and procedures and suggests modifications to conform to standards. Partners with the auditing team to identify and implement solutions to resolve quality issues.Collaborates with internal and external business partners to develop program improvements and to re-engineer processes to support automation, quality improvements and compliance with NCQA, DOBI, and all other oversight entities. Support all process improvement initiatives.Generates customized detailed reports to summarize findings, identify quality problems and suggest improvements in processes and policies. Work with Knowledge Management to disseminate new policies and procedures to the appropriate associates.Evaluate and test new or modified procedures ensuring that they are functioning according to credentialing processing requirements and conform to established policies.Support the enhanced quality review needs of new hires and associates completing new transaction or systems training.Supports Credentialing Committee activities including post committee activitiesTrain other credentialing associates. Provide support to other IBC FOC areas as needed.Monitor credentialing process for generating both provider and member notifications. This includes but is not limited to ensuring timely reporting and confirming completion of all tasks (Welcome letters, Recred notifications, Term/affirmation letters, etc.)Coordinate onboarding of FTE and vendor resourcesSubmit and Manage Credentialing Tickets Performs additional duties as assigned.Monitor providers who do not require full credentialing to determine if their status have changed (PNC, etc.)Assist management with production and quality reporting for Associates within the credentialing department.Assist with the creation and editing of DLPs, Business Decisions, Program evaluations, and Corrective Action Plans.Coordinate Standard and Expedited TerminationsSkills, Knowledge and AbilitiesBachelor’s degree in related field or equivalent experience with a minimum of three years quality assurance or auditing experience.Excellent analytical ability, decision-making skills and mathematical skills are required.Comprehensive knowledge of Microsoft Office.Working knowledge of database and statistical software such as DB2, UDB and MS Access desired.Proven Ability to multi-task.Critical DimensionsTeamwork FocusTechnical KnowledgeTechnical InnovationAnalysis of Educational/Business NeedsStrategic ThinkingInitiativePlanning and Organizing – Attention to DetailFocus on Quality Assurance/Education/Business NeedsPerformance ExpectationsPerform the number of claim reviews at 98% accuracy to meet the cycle time and informational needs requirements of the business units that are supported.Write clear reports with appropriate analysis of data and completion within time expectations. Use appropriate software to maximize efficiency and effectiveness.Communicate effectively, in both written and oral modalities, within work group and with internal and external customers. Function effectively in a team environment.Maintain proficiency in all required systems.Provide education and cross-training for other Quality Data Analysts and other business units as needed.Balance multiple demands and set appropriate priorities.Job Type: Full-time
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