Payment Integrity Quality Program Implementation Specialist I or II

Blue Cross of Idaho; Meridian (ID); On-site; USD 60,000 - 103,000; Full time

Job summary

Blue Cross of Idaho in Idaho is seeking a Quality/Program Implementation Specialist responsible for analysis, management, implementation, and ongoing optimization of editing and auditing concepts and customizations. You will lead cross-functional implementation projects, develop project plans, track milestones, identify risks, and communicate status to stakeholders throughout the lifecycle.

The salary range at posting shows Level I $60,048–$84,069 and Level II $73,321–$102,650, with an annual

Qualifications

• 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.
• Lead and coordinate cross-functional implementation projects, ensuring deliverables are completed on time and aligned with business objectives.

Responsibilities

• Develop project plans, track milestones, identify risks, and communicate project status to stakeholders throughout the project lifecycle.
• Coordinate multiple simultaneous initiatives while managing competing priorities and deadlines.
• Prepare and present in-depth written technical assessment.

Skills

Analytical skills

Project management

Stakeholder management

Education

Bachelor’s Degree or equivalent work experience

Two years’ relevant work experience equals one year of college

Job description

Blue Cross of Idaho is seeking a Quality/Program Implementation Specialist to be responsible for the analysis, management, implementation, and ongoing optimization of editing and auditing concepts and customizations. This role partners with multiple internal business areas to plan, coordinate, and manage implementation projects, ensuring successful delivery of business objectives, process improvements, and operational efficiencies. The ideal candidate combines strong analytical skills with project management capabilities to drive initiatives from planning through execution while effectively managing priorities, timelines, stakeholders, and outcomes. 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. Lead and coordinate cross-functional implementation projects, ensuring deliverables are completed on time and aligned with business objectives. Develop project plans, track milestones, identify risks, and communicate project status to stakeholders throughout the project lifecycle. Coordinate multiple simultaneous initiatives while managing competing priorities and deadlines. 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.

Blue Cross of Idaho has taken our role as an Idaho-based health insurance company to heart since 1945. As a not-for-profit, we are driven to help connect Idahoans to quality and affordable healthcare while building strong networks and services. We aim to create a brighter future for all with the help of customer-centric professionals.

Your Health and Wellness Matters

At Blue Cross of Idaho, we care about the health and well-being of our employees. Our benefits aim to help make your life easier, healthier and more balanced.

Your Career Development Matters

We believe in employee growth, which is why we offer training, tools and numerous resources to assist with professional development.

Your Community Matters

Our employees care deeply about Idaho. We work together to positively impact communities throughout Idaho, and contribute our time through volunteering.

Blue Cross of Idaho will extend reasonable accommodations to qualified individuals with disabilities who are otherwise not able to fully use electronic and online job application systems. Equal Opportunity is the Law EEO is the Law Supplement E-Verify Pay Transparency