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Position Description

Arkansas Blue Cross and Blue Shield - EXEMPT POSITION DESCRIPTION

Position:  Mgr Marketplace Account Liaison
Reports To: 
Division:  Exch Svs Claims (0071)
Company:  ABCBS
Location:  Label
Job Code:  030514
Min Salary:   67200
Date Posted:  3/5/2013

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Position Specific Requirements: No position specific requirements

Job Summary
The State of Arkansas is partnering with HHS to operate a State Partnership Exchange. To facilitate this relationship, HHS requires QHP issuers operating in a State Partnership Exchange must have a designated Federal Account Manager, who will serve as a point of contact between the QHP issuer and CMS/HHS/ CCIIO/Medicaid for operational questions and issues related to Marketplace and this position will also serve as the designated Marketplace Account Liaison for ABCBS for the State of Arkansas Private Option activities. The Marketplace Account Liaison will assist ABCBS by providing policy clarifications and other assistance with all Federal and State programs on an as-needed basis. The incumbent will serve as the primary ABCBS liaison with the Federal and State authorities concerning operational areas of the Federal Marketplace Exchange the State Medicaid Private Option.  Additionally, this position will serve as the Enterprise contact point for the Multi-State Plan with BCBSA and be the designated contact for the Office of Personnel Management in the Federal Government oversight of these plans.  While compliance and audit responsibilities are assigned to the EVP Strategy Office within the Enterprise, this position will be the Operational lead for directing and monitoring and coordination of compliance and audit tasks that are operational in nature.

• This position will be assigned responsibilities as needed for the Enterprise to successfully participate in the State(s) Exchanges, Private Exchanges, and other Exchange operational activities. These assignments will be at the discretion of the Executive of Enterprise Exchange Services.
•Ability to read, interpret and translate Federal and State rules, bulletins and other regulatory documents into actionable plans to ensure ABCBS complies with all regulations.    
• 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 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.
• Build and maintain positive relationships and rapport with State and Federal level staff as needed.
• Coordinate and assist in the integration of claims, enrollment, and billing activities interacting with all levels of leadership within BCBSA and the Enterprise.
• Coordinate and assist in the operational in nature compliance and audit tasks mandated by the State, Federal (CMS/OPM), for both the local and MSP involving 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.
This position will attend meeting as necessary both in state and out of state and represent ABCBS for the Federal Marketplace, BCBSA MSP, OPM and the State of Arkansas Private Option.  Within 3 workdays, after each meeting, this position will prepare a concise report for their executive management to analyze the meeting discussion and prepare action items, recommendations, etc.

The Marketplace Account Liaison 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 and external staff. Necessary skills require complete and thorough written documentation, presentation skills and effective facilitation of internal meetings with management staff.

This position will be the chair of the Exchange Government Programs Committee that will coordinate the operational work groups, projects, etc necessary in order to be meeting the CMS, OPM, State of Arkansas or BCBSA for the MSP requirements.

Nature & Scope
The Marketplace Account Liaison reports directly to the Executive Enterprise Exchange Services. The incumbent works closely with all members of Enterprise Exchange, other ABCBS management, AID and CMS/HHS/ CCIO to ensure that The company’s exchange products are managed and supported to the best of our ability. 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.


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. Excellent working knowledge of quality principles and theories
2. Ability to work in a high stress environment at times with numerous competing priorities.
3. Adept at conflict management
4. Ability to organize workflow for maximum efficiency and maintain detailed, organized records for multiple simultaneous projects
5. Ability to read documents (rules, regulations, bulletins, etc) released by CMS/HHS/CCIIO and State of Arkansas and determines impacts to ABCBS operations.  Ensure any changes needed are communicated to management and follow through to ensure compliance with such.      
6. Advanced research and reading comprehension skills, able to interpret and develop action plans based on complex and multi-faceted information
7. Ability to gain trust and commitment from others, and to build strategic working relationships.
8. Ability to analyze and draw objective, independent conclusions based on multi-faceted factual and subjective information
9. Strong decision-making abilities, including development of clear action plans, using innovative yet practical methods
10. Ability to adapt action plans based on customer needs and multiple priorities.
11. Ability to confidently, succinctly, and professionally communicate thought processes and conclusions via written and verbal communication
12. Ability to produce quality work under pressure and time constraints
13. Ability to be scheduled for work on short notice and overtime – nights, days, Saturdays, Sundays or holidays – and travel on short notice.
14. Knowledge of government audit best practices.
15. Knowledge of government compliance and documentation requirements.
16. Knowledge of technical details of HIPAA 820(Financial) and 834(Eligibility) transactions, which serve as the basis for all enrollments and payments from CMS and Medicaid.    
17. Sills in Compliance and Audit coordination
18.  Experience with CMS and other Federal or State Agencies that oversee operations.

Minimum Job Requirements

1. College degree in Business Administration or related field and experience as primary contact in management role dealing with government entities or large government projects 


Experience in management role as primary contact dealing with government entities or large government projects.  

2. Experience in development of business requirements to support internal processes (will be tested during interview process).

3. Operational experience in customer service, membership enrollment & billing and/or claim processing is highly desirable.

4. Experience with audit of operational procedures by external entities, experience with Federal or State regulators is highly desirable.

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.

1.Primary Responsible is to serve as our liaison between the AID and HHS regarding Exchange activities.
2. Serve as point of contact for issuer to address questions and issues related to QHP certification and requirements.
3. Track and prioritize requests from AID, HHS, and internal Enterprise staff.
4. Support project request needs for internal/external Reporting. (Includes claims, membership, and billing)
5. Ensure the Claims Exchange Manager is informed concerning the status of Exchange projects.
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 for Exchange Operational Staff.
8. Ensures all assigned tasks are completed by the 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.
15. Attention to details in the interpretation of regulatory documents issued by CMS/HHS/CCIIO/Medicaid.
16. Maintain CMS Marketplace Help Desk inventory and status of all tickets.
17. Primary responsibility for HICS system developed by CMS for tracking issuer appeals.  Daily monitoring of this system is required to determine if any appeals have been assigned to ABCBS.  Ensure any appeals assigned are resolved within CMS time frame requirements.
18. Serve as primary contact for Enterprise Exchange Services concerning any audit (external or internal ABCBS) or compliance/control questions and/or issues.  
19. Lead the Exchange Government Programs Committee.
20.Coordinate applicable staff assigned to the audit of process that involve operations.
21. Control, Monitor, follow up etc, tasks assigned to Exchange Operations from ABCBS Compliance, State of Arkansas, OPM, BCBSA, etc.
*******    END    *******

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