Payment Integrity Quality Program Implementation Specialist I or II

Blue Cross of Idaho is seeking a Quality/Program Implementation Specialist to be responsible for the analysis, management and implementation of editing and auditing concepts and customizations. This person will collaborate with multiple internal business partners to find opportunities for continuous process improvements.

We are looking for a Specialist with:

Level I:

Experience: 2 years’ analytical, health industry, or relevant experience

Education: Bachelor’s Degree or equivalent work experience (Two years’ relevant work experience is equivalent to one-year college)

Level II:

Experience: 4 years’ analytical, health industry, or relevant experience

Education: Bachelor’s Degree or equivalent work experience (Two years’ relevant work experience is equivalent to one-year college)

What a day may look like:

• Monitor editing and auditing programs for trends and process improvement opportunities.
• Present issues, lead and/or participates in discussions and develop conclusions with internal and external professionals.
• Provide functional requirements working with software developers to find the best solution to meet various projects.
• Review contracts and policy language to ensure claims processing results match the intent of contract and policy terms.
• Prepare and present in-depth written technical assessment.
• Perform other duties and responsibilities as assigned.

As of the date of this posting, a good faith estimate of the current pay range for a level I is: $60,048 - $84,069 and a level II is: $73,321 - $102,650. 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, travel requirements, internal equity, 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.