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Position Description

Arkansas Blue Cross and Blue Shield - EXEMPT POSITION DESCRIPTION

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Position:  Enterprise Exchange System Coordinator
Reports To: 
Division:  Enterprise Exchange Srvcs (0071)
Company:  ABCBS
Location:  Label
Job Code:  211013
Min Salary:   50000
Date:  11/30/2012

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Position Specific Requirements: No position specific requirements


Job Summary
The Enterprise Exchange System Coordinator is responsible for providing technical expertise, project management, and implementing process improvement initiatives for Arkansas Blue Cross Blue Shield.  Primary duties for the incumbent include analysis and interpretation of PPACA guidelines and rules, then the development of technical requirements to implement sound IT solution on behalf of the division.   Additional duties would include extensive research for corporate initiatives concerning Enterprise Exchange Services.  With heavy emphasis on information technology as an enabler for the Exchange environment, this position will serve as a liaison with IT to develop sound business requirements.    This position will interact heavily with the various Exchange Work Team Leads and in particular, IT interface Exchange Team Lead.

• During the start-up of the Enterprise Exchange Services area, this position will be assigned responsibilities as needed for the Enterprise to successfully participate in the State(s) Exchanges, Private Exchanges, and “off exchange marketing”.   These assignments will be at the discretion of the Claims Manager of Enterprise Exchange Services.
• Position will be asked to be an active participant in the Enterprise Exchange Work Groups.  
• Responsibilities will be placed on this position that will entail working beyond normal working hours or normal work week, due to the many unknowns of the upcoming Exchange and other Health Care Reform provisions.
• Continuous evaluation of internal processes and operations to ensure maximum efficiency and to forecast and address needs of ABCBS to comply with the PPACA.
• Coordinate and assist in the integration of claims, enrollment, and billing activities interacting with all levels of leadership within BCBSA and the Enterprise.
• Adhere to the standards and guidelines of the Enterprise, Government Agencies, and the BCBS Association in the performance of all duties. The ability to successfully operate in an environment with heavy compliance and regulatory requirements will be mandatory for this position.

The System Coordinator must assume a self-directed leadership role, work independently, understand project management methodologies and quality principles, and possess superior communication skills while developing and maintaining diplomatic rapport with all internal staff.  Necessary skills require complete and thorough written documentation, presentation skills and effective facilitation of internal meetings with management staff.

Nature & Scope
The Enterprise Exchange System Coordinator reports directly to the Claims Manager of Exchange Services. The incumbent works closely with all members of the AMISYS configuration staff and systems staff; Data Warehouse staff; ODS; AHIN; Actuarial and other Enterprise wide technical staff; internal and external users; other Blue Cross Blue Shield plans to ensure that our exchange products are managed and supported.  The incumbent receives work assignments directly from Exchange Claims Manager and often works self imposed deadlines and CMS deadlines.   Other assignments may vary broadly in subject matter requiring the incumbent to be knowledgeable in many topics and flexible in order to meet these many needs. The incumbent must rely on their skills in leadership, project management, research and data analysis, problem analysis and solving, organizational planning, group management, statistical measurement, reporting and documentation.

Communication

The incumbent must possess excellent communication skills, both oral and written to ensure that a productive and cooperative climate is maintained with all customers internally and externally. The incumbent will be required to present to various committees information as it relates to the customer service division.


Skills, Knowledge and Abilities

1. Possess effective interpersonal skills.
2. Ability to communicate effectively both orally and in writing.
3. Effective ability to analyze a problem and develop a solution.
4. Ability to establish goals and objectives and plan methods to achieve these goals.
5. Demonstrate stability of performance under pressure and/or opposition.
6. Ability to be scheduled for work on short notice and overtime - nights, days, Saturdays, Sundays or holidays - and travel on short notice.
7. Possess effective organizational skills.
8. Possess a basic understanding of the healthcare industry.
9. Ability to influence events to achieve goals.
10. Ability to make decisions based on facts, intuition or experience and assume the responsibility for those decisions

Minimum Job Requirements
  • 1. Bachelor's degree, preferably in a business or healthcare management related field, OR experience in a healthcare or health insurance environment.
  • 2. Project Management Experience - (Provide documented account of incumbent's leadership experience using project management methodologies, i.e. project objectives, timeline, outcomes, incumbent's role. (Documentation will be required for interview.)
  • 3. Development of technical and systems business requirements. (Documentation will be required for interview).
  • 4. Proficient written communication skills. (Documentation will be required.)
  • 5. Proficient working knowledge of PC and office software applications

Security Requirements
This position is identified as level three (3). This position must ensure the security and confidentiality of records and information to prevent substantial harm, embarrassment, inconvenience, or unfairness to any individual on whom information is maintained. The integrity of information must be maintained as outlined in the company Administrative Manual.

Segregation of Duties
Segregation of duties will be used to ensure that errors or irregularities are prevented or detected on a timely basis by employees in the normal course of business. This position must adhere to the segregation of duties guidelines in the Administrative Manual.

PRINCIPAL ACTIVITIES OR ACCOUNTABILITIES (Essential Functions of Job)
1. Responsible for  project management of  Exchange IT projects, including preparation and maintenance of project plans, identifying resources and individual responsibilities, scheduling and calendar management
2. Contribute to and help support Enterprise-wide undertakings and commitments, including but not limited to ANSI HIPAA transaction requirements, COBC, ICP, HDMS reporting, BHI reporting, Data Warehouse extracts, Actuarial extracts, AHIN and Customer Service Workstation.
3. Support project request needs for internal/external Reporting.  (Includes claims, membership, and billing)
4. Ensure the Claims Exchange Manager is informed concerning the status of Exchange projects.
5. Support Health Advantage IS staff with analysis, testing, and implementation of AMISYS Exchange system development and updates.
6. Contribute to and support the Enterprise strategic and operational planning process to include total quality management philosophies.
7. Assists in testing on special projects and surround processes developed by the Health Advantage programming staff.
8. Ensures all tasks are completed by the assigned target dates.
9. Maintains the production systems at the highest levels of efficiency.
10. Interacts with internal and external customers and systems areas in resolving problems and initiates vendor and internal system change requests as appropriate.
11. Ensures that a cooperative and productive climate is maintained with all internal and external contacts.
12. Ensures that the Supervisor and/or Manager are aware of all problems and the action that is being taken to correct the problem(s).
13. Becomes knowledgeable of the enterprise functions to the level necessary to accomplish assigned tasks, including Enterprise Exchange integration initiatives.
14. In conjunction with the Supervisor and Manager, ensures that personal business and professional skills are continuously enhanced to maintain business and technical acumen, commensurate with the rapidly evolving health care industry and technological innovations/developments.

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