Value Based Program Specialist

Healthy Careers Start Here

At Blue Cross & Blue Shield of Mississippi, we encourage professional growth in a challenging and fast-paced atmosphere. Our 'be healthy' culture promotes health and wellness at all levels of the Company, and we provide our employees with the time, tools and resources to commit to a healthy lifestyle.

The Value Based Program (VBP) Specialist is responsible for monitoring the quality and operational efficiency of VBP Claims & Member Enrollment inventories against established departmental and corporate benchmarks. This position ensures claims are accurately adjudicated in accordance with the Advanced Blue Primary Care Home as well as member attribution and enrollment accuracy across all lines of business. The incumbent is responsible for identifying, creating and proposing quality improvements to enhance the claims processing procedures that affect Clinics under VBP and BCBSMS members. This position will remain closely aligned with the VBP Clinic Billing Specialists to coordinate corrections to claims, biometrics, and wellness plans to ensure a positive member outcome. The position also requires communication with other Blue Plans to coordinate Host Claims processing. This position will also utilize a data driven approach to provide monthly analysis of VBP Claims activity and trends.

Job-Specific Requirements: ? Bachelor?s degree or four years of experience in claims processing or adjustments. ? Must have at least three years of experience in claims analysis and quality improvement activities. ? Must have prior experience in medical claims processing and related operational processes. ? Experience in analyzing and creating business processes and workflows is preferred. ? Must demonstrate a logical thought process in order to analyze problems, and then identify and implement solutions. ? Must demonstrate a logical thought process in order to analyze problems, and then identify and implement solutions.

Blue Cross & Blue Shield of Mississippi is an Equal opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. We offer a comprehensive benefits package that is worth approximately one-third of the salary compensation. Our benefits program is among the best in the health care field. We are looking for employees who can bring their experience, expertise and dedication to work for our customers.

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