Provider Network Consultant II - Provider Business Services

The Provider Network Consultant II in Provider Business Services leverages data analytics to support Provider Engagement Support operations and corporate strategies. This role is responsible for analyzing healthcare data related to networks, claims, utilization, EDI transactions, clinical data, credentialing, provider engagement, and cost management, as well as activities supporting the development and implementation of corporate initiatives. Key responsibilities include performing analytical design, data gathering, and in-depth analysis to identify trends and opportunities for improvement in healthcare utilization and quality. The position creates and publishes reports and dashboards, along with ad hoc analyses, to fulfill corporate objectives and meet obligations to employer groups, providers, executives, and other internal stakeholders. Strong collaboration, organizational skills, and knowledge of provider contracts, clinical guidelines, and claims processes are essential to deliver actionable insights that strengthen provider relationships, support administrative efficiency, and enhance the quality and cost-effectiveness of care.

• Bachelor's Degree
• 3 years of experience working in the healthcare industry
• General knowledge of member and provider contract benefits, clinical guidelines, medical policy and claims processing for all lines business or equivalent healthcare related industry knowledge
• Experience in a position communicating information orally and written
• Experience in a position exercising independent judgment and decision making
• Experience in a position resolving difficult and stressful situations
• Experience in a position identifying and solving problems
• Experience working with various Microsoft Office programs
• Willingness to travel out of the office and overnight
• Experience managing multiple projects with various priorities
• Experience participating in initiatives to improve productivity, quality or efficiency of processes
• Experience in a position using analytical skills
• Experience or understanding of provider workflows and technologies
• Experience understanding and interpreting medical policy and member benefits
• Experience leading and controlling effective meetings, both internally and externally
• Experience in building relationships and networking to obtain the trust of business owners, Information Technology (IT), and stakeholders
• Experience in a position preparing correspondence, contracts, documents etc.
• Familiarity with medical terminology
• Exposure to claims processing procedures
• Experience in a position organizing and prioritizing tasks
• Experience with statistical reporting (e.g. Crystal Reports, Tableau, Excel, etc.) preferred
• Experience in a position leading complex projects preferred
• Experience in a position working independently under little or no supervision preferred
• Minimum of three years of experience analyzing data
• Demonstrated experience analyzing or reporting data sets using tools such as WinSQL, Toad, Crystal Reports, Excel, Tableau or PowerBI
• Analytical and technical skills necessary to execute each phase of analysis including methodological design, data integration, and data visualization
• Demonstrated successful organizational skills, creativity, problem-solving skills, and managing multiple priorities
• Thorough knowledge of how a company in the healthcare industry operates and its business relationships, and how these relationships directly impact analytical processes
• Strong attention to detail with excellent organizational skills
• Working knowledge of Blue Cross and Blue Shield of Alabama Corporate data warehouse or production database

• NOTE: Can be filled at a higher level based on experience

The work schedule for this position will be hybrid (onsite/remote). Business areas reserve the right to require associates to return to the office as needed, based on performance or other business considerations. A hybrid work schedule is subject to amendment or termination at any time by the Company.

By submitting a job application, I attest that all information to the best of my knowledge is true and accurate. Furthermore, I understand that any information provided by me throughout the job application process is subject to verification including, but not limited to work experience, education, assessment (test) and interviews.
We appreciate your interest in Blue Cross and Blue Shield of Alabama 'The Company'. The Company does not discriminate in hiring or employment on the basis of race, color, religion, creed, sex, sexual orientation, gender identity, national origin, age, disability, genetics, status as a disabled or protected veteran, or because of citizenship status in the case of a citizen or intending citizen. No question on this application is intended to secure information to be used for such discrimination.
Blue Cross and Blue Shield of Alabama is an independent licensee of the Blue Cross and Blue Shield Association