Healthcare Business Consultant - permanent

Summary

• Leads/Directs the ongoing business operations; overseeing 70 Team Members for the exchange of 300 Million electronic transactions connected to over 30,000 providers and 7,000 submitters.   
• Oversees a wide variety of Corporate Projects related to the Electronic Business Interchange Area including requirements definition, internal and external testing as well as product deployment and conversions. 
• Internal or External Customer service and relationship management related to Clearinghouse, Provider Portal, and Secured Web Services for Help Desk and analytical support.
• Responsible for managing the budgets and producing revenues related to the Electronic Business Interchange Group.

 

Essential Duties and Responsibilities

·         Leads a centralized business unit with a diversity of functions that entail External Consulting, Help Desk Support, Business Analysts, Testing, Production Monitoring and Customer Registration services.

·         Working independently, responsible for strategic and day to day support for technology related initiatives for a business unit. 

·         Manages existing client relationships to make development of client's business systems more effective and efficient.

·         Builds quantitative and qualitative business case for each project and supports Conceptual Design and Business Requirement Definitions. 

·         Develops and promotes relationships with both client and project teams.

·         Serves as liaison with other Corporate Business Units, IT and External Constituents for Electronic Transaction Exchange.

·         Communicates changes which impact client or business including changes in staff, technology, policy, procedures, or practices. 

·         Responsible for the growth and expansion of Electronic Data Interchange and Provider Web Transactions.

·         Develops and manages multiple client relationships.

·         Manages client expectations at all levels of client organization and ensures client satisfaction. 

·         Has wide latitude in determining creative solutions to strategic and operational needs. 

 

Education and/or Experience

·         Bachelor’s Degree in related field required.  Master’s Degree in related field preferred.

·         Minimum eight (8) years related experience preferred.

• Excellent analytical, organizational, verbal and written communication skills.

·         A high proficiency level in specific job related skills is required.

• Other related skills and/or abilities may be required to perform this job.

• In depth knowledge of Electronic Business Interchange as it pertains to the BCBSM Clearinghouse, Provider Portal (webDENIS), other secured web services, e-prescribing, and the internet claims submission tool.
• Industry awareness and knowledge of trends in Health Information Exchange.
• Demonstrated ability to grow and expand EDI Business.
• Background/understanding of the technology environment and tools that support the exchange of electronic services.
• Keen understanding of the HIPAA Compliance and Security Measures for EDI and Web Transactions including the Corporate Standard Bearer Role for the Organization. 
• Strong External Relations skills related to the promotion and servicing of Electronic Services with all levels of external constituents/customers such as Providers, Associations, Groups, Software Vendors, BCBSA and other Blues Plans, etc.   
• Vast business knowledge of a multitude of corporate areas including claims, provider, group, membership, BCN, Dentemax, FEP, and NASCO.
• Highly effective and proficient at preparing and conducting external presentations to a wide variety of audiences.