Blue Cross and Blue Shield of Louisiana

• Identifies and assists with the implementation plan of Information Technology Service Management (ITSM). • Reviewing management information and trends to ensure services meet agreed upon service levels. • Conducts maturity assessments against the current process activities to demonstrate areas of improvement or concern. • Provides insight into the ITSM lifecycle and roadmap to define next steps of process maturity. • Accountable for complying with all laws and regulations associated with assigned duties and responsibilities.

• Design, develop, document, test, and debug software systems • Serve as a technical expert on projects • Participate in full development life cycle • Consult with end users for program refinement

• Resolves level two problems presented by our customers through direct telephone, self-service and email contact. • Resolving service incidents with little or no assistance from management or support staff. • Proactively identify and deliver coaching/training opportunities on incoming calls, support tickets and e-mails, and provide guidance to IT Support Analyst to promote growth. • Look for opportunities to enhance and improve customer's satisfaction. • Create and maintain support documentation for department and communications to customers. • Handles problems that first tier support is unable to resolve and escalates more complex problems to higher level technician or supervisor to quick resolution of more complex problems. • Provides second level phone support for all IT Service incident/requests by recording and tracking all calls using Service Desk Application to ensure effective operations. • Identifies opportunities and recommends methods to improve customer service and work processes. • Assists in design and implementation of quality improvement initiatives on departmental and organizational levels. • Interviews users to gather the necessary information about problems and provides problem analysis and diagnosis in order to resolve or direct to the appropriate support group. • Assists the team in resolution of issues to ensure effective operations and resolution. • Understands IT Departmental Goals and Objectives and delivers work products to contribute to those goals.

Role Description Responsible for assisting Medical Group and affiliate practices to implement best clinical practices with the goal of achieving the quadruple aim - better outcomes, lower costs, improved patient experience, and improved clinician experience. This position is responsible for working with practices to maximize the use of data to facilitate population health strategies to excel in value-based models. Partner with practices to facilitate process and workflow redesign efforts to achieve improved health outcomes. Success will be measured by expected reduction in total cost of care and expected improvements in quality and efficiency metrics. Qualifications - Bachelor's degree from an accredited university in Business, Nursing or a related field is required. - Education beyond bachelor's degree (e.g. Master of Business Administration, Nursing Degree, Health Administration, etc.) is preferred. - Four years of related experience can be used in lieu of a Bachelor’s degree. - 5 years of experience in a dynamic, fast-paced healthcare environment is required. - 2 years of demonstrated experience in analysis of financial and healthcare data is required. - Experience working closely with physicians and their administrative staff in a clinical setting is required. - Experience implementing successful change management processes in organizations is required. - Experience with creating practice workflows to optimize care delivery is preferred. - Experience with QI change management preferred. Requirements - Thorough knowledge of the ambulatory health care and Patient Centered Medical Home, ACOs or similar population health and quality improvement models of care delivery. - Must be able to represent the company as a population health subject matter expert. - Excellent presentation, interpersonal and oral and written communication skills are required. - Requires strong interpersonal, negotiation, sales and relationship building skills. - Must be able to successfully facilitate meetings, committees, seminars, and workshops. - Requires the ability to teach practices how to maximize technology. - Microsoft Office Software proficiency is required. - Requires excellent critical thinking, problem solving and problem resolution skills. - Must be able to manage multiple priorities and meet deadlines. - Requires the ability to work independently, on diverse teams and with internal and external staff at all levels. - Ability to travel approximately 20% of the time for in-state and out-of-state business is required. Accountabilities and Essential Functions - Works directly with the Director of Population Health Services and the Clinical data analyst to develop an Annual Plan for Performance Improvement. - Supports practice staff in the implementation of the Medical Group and affiliate practices’ population health and quality improvement programs. - Assists practices in understanding their practice transformation needs. - Creates policy and procedure templates and customized flows for care coordination integration. - Provides information and resources to practices, change management coaching and practice transformation. - Assures submissions of the practices’ data submissions and/or data integration requirements are clearly communicated. - Oversees the Medical Group and affiliate practices agreements with Medical Group and affiliate practices’ population health and quality improvement program. - Accountable for complying with all laws and regulations associated with duties and responsibilities. Additional Accountabilities and Essential Functions - Perform other job-related duties as assigned, within your scope of responsibilities. - Job duties are performed in a normal and clean office environment with normal noise levels. - Work is predominately done while standing or sitting. - The ability to comprehend, document, calculate, visualize, and analyze are required.

Role Description Individuals within the Associate Software Quality Assurance Engineer role deliver automated solutions for software processes. They plan, organize, coordinate, and track testing activities to ensure the successful deployment of projects. This role involves: - Using technical skills, expertise, and application knowledge to support clients, developers, and testers. - Providing knowledge transfer and training to the test team as needed. - Performing or participating in various types of testing and post-implementation reviews as determined by the project. - Helping to ensure continuous improvement in Quality Assurance processes. A QA engineer is expected to: - Identify opportunities for inserting more quality within software processes. - Design and execute QA tests. - Run tests for databases, systems, networks, applications, hardware, and software. - Identify bugs and quality issues in development, service, or business processes. - Collaborate with other business units to understand the business and ensure their quality needs are being met. QA Engineers also interact with various development teams, project managers, internal and external customers, senior management, and external vendors. They must have: - An in-depth understanding of the business environment. - Strong analytical and communication skills. - The ability to work well within a team environment. Accountable for complying with all laws and regulations associated with duties and responsibilities. Qualifications - Bachelor's degree in Computer Science, Information Systems, Business Management, or specialized training/certification, or four years of related work experience can be used in lieu of a degree. - Minimum of 1 year of experience with quality assurance testing or successful completion of a relevant Louisiana Blue internship. - Knowledge of MS SQL Server, preferred. - Experience with end-to-end QA testing efforts associated with project work, required. - Basic understanding of testing for web, client-server, or mobile applications. - Some experience in at least one of the following technical competencies preferred: Selenium, .NET (C#, VB, etc.), VB Script, SQL, HTML5, JavaScript, NUnit, C, XML. - Ability to develop, document, and maintain functional test cases and other test artifacts such as test data, data validation, and scripts. - Create test cases consisting of all required testing steps needed to conduct data validation. - Develop validation/regression test scripts needed to perform quality assurance testing of user stories (requirements). - Execute all data validation using tools and scripts, documenting and communicating all test results. - Review functional and design specifications to ensure full understanding of individual deliverables. - Identify any potential quality issues per defined process and escalate potential quality issues immediately to management. - Engineer test data from multiple sources to verify and validate test conditions. - Report and document defects found during testing and work across functional teams to resolve defects. Requirements - Works on low complex or medium complex projects with more senior QA engineers. - Works multiple projects as a team member. - Works with project team and peers to understand customer needs. - Develops (codes) and tests functional solutions such as databases, queries, views, reports, and dashboards, under supervision. - Helps to troubleshoot automation scripts, systems, and software. - Tracks performance and production issues. - Escalates production issues as appropriate. - Ensures the scripted code and tests are within required quality standards. - Adheres to process, policies, and standards. - Works with senior automation engineers to keep customers informed about quality problems and resolutions. - Tracks and reports out on issues and enhancement requests for the business in a timely manner. Benefits - Resources to live well and be healthy. - Opportunities for continued learning and skill development. - Support for professional growth. - Engagement in local community service.

Role Description Responsible for coordinating, processing and managing all in-patient and out-patient claims from a medical standpoint to ensure proper administration of contractual limitations and exclusions to include medical necessity, while maintaining compliance with regulatory guidelines. Qualifications - High School Diploma or equivalent is required - 4 years of recent LPN experience providing direct patient care with one year of authorization, medical review experience and case management is required - Knowledge of standardized code sets and medical terminology is required - Proficiency in the use of standardized code sets is required - Must demonstrate excellent interpersonal, administrative, and telephone skills - Working knowledge of MS Office is required - Demonstrated ability to handle multiple tasks in customer friendly manner while maintaining performance standards is required - Knowledge of health insurance contracts/benefits is preferred - Current, unrestricted LPN license in the state of Louisiana and/or in the required jurisdictions, or where services are provided required - CPUR or CPC certification is preferred upon hire; required within 24 months in position - A comparable professional medical review or case management certification is preferred Requirements - Reviews medical claims and requests for services and applies medical judgment and/or criteria in determining the benefits for pre-services and post-services according to contractual benefits and limitations - Prepares documentation of medical information, completes research, makes recommendations, and refers potential denials to the Medical Directors and Management, when necessary - Completes correspondence correctly when necessary to providers and subscribers to ensure that customers are aware of the determinations and appeal processes/rights meeting all regulatory standards - Meets targeted expectations for staff and unit performances as required by BCBSLA and department management - Collaborates with team members and communicates to the supervisor suggestions for improvement to ensure adherence to the corporate initiative of diversity - Perform other job-related duties as assigned, within your scope of responsibilities - Job duties are performed in a normal and clean office environment with normal noise levels - Work is predominately done while standing or sitting - The ability to comprehend, document, calculate, visualize, and analyze are required Benefits - We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally and serve our local communities - Company properties are smoke and tobacco free

Role Description Researches and verifies complex claims information to ensure the accurate and timely processing of claims. Enters all information needed to process claims. Identifies inconsistencies and makes necessary corrections. Accountable for complying with all laws and regulations associated with duties and responsibilities. Qualifications - High School Diploma or equivalent required - Associate's degree preferred - 1 year of related clerical or data entry experience required - A medical office or medical coding diploma can be used in lieu of one year of experience - Completion of the Medical Assistant, Coding & Insurance Pathway from BRCC can be used in lieu of one year of experience - Claims processing or claims coding experience preferred - Must be able to enter data at 4000 keystrokes per hour - Medical coding training preferred - Must demonstrate critical thinking and problem-solving skills - Familiarity with medical and health insurance terminology preferred - Demonstrated verbal and written communication skills - Must demonstrate PC skills including Microsoft Office (e.g., Word, Excel, Outlook, etc.) Requirements - Reviews and corrects scanned claims documents upon receipt - Enters coded information and checks claims for completeness and accuracy - Identifies and resolves inconsistencies - Returns claims requesting missing information in accordance with established guidelines - Researches procedural questions using supporting documentation - Maintains and records information necessary for accurate production tracking - Rejects, redirects misrouted claims, or sends back claims when information is incomplete or inaccurate - Researches procedural questions in the training manual Benefits - Resources to live well and be healthy - Opportunities for continued learning and skill development - Support for professional growth - Community service involvement

• Accurate processing of claims edits • Determining primacy for the Coordination of Benefits (COB) • Adjusting previously paid claims and initiating procedures to recover funds on overpaid claims • Complying with all laws and regulations associated with duties and responsibilities • Communicates with internal and external contacts to provide necessary and accurate information for claims processing • Reviews, researches, and makes necessary updates to claims

• Ensures accurate, complete, and compliant clinical documentation that appropriately reflects severity of illness, risk of mortality, and supports correct reimbursement. • Partners closely with providers, coding teams, and practice participants to drive documentation quality, regulatory compliance, and value-based care initiatives. • Develops and implements standard processes, job aids, and error prevention tools to strengthen clinical documentation integrity across participating practices. • Educates providers and office staff on best-practice clinical documentation standards to ensure accuracy, completeness, and compliance. • Conducts prospective and retrospective reviews and prepares analyses and reports to identify trends, gaps, and improvement opportunities. • Provides guidance and consultation to internal practice staff to improve coding proficiency and documentation accuracy. • Collaborates with population health and practice teams to support quality programs, value-based initiatives, and standardized data abstraction processes. • Advises practice staff on compliance with applicable federal, state, and local regulations related to Medicare coding and documentation guidelines.

Role Description Duties may include the following responsibilities or functions required to support the claims unit: - Accurate processing of claims edits. - Determining primacy for the Coordination of Benefits (COB). - Adjusting previously paid claims. - Initiating procedures to recover funds on overpaid claims. - Analyzing, investigating, and resolving problem cases. - Executing recovery processes. - Completing special projects. - Accountable for complying with all laws and regulations associated with duties and responsibilities. Qualifications - High School Diploma or equivalent required. - 2 years in medical claims processing required. - Coordination of Benefits (COB) processing experience preferred. - Strong analytical ability, including strong logical, systemic, and investigative thinking. - Strong oral and written communication skills and human relations skills are necessary. - Working knowledge of relevant PC software. - Ability to prioritize multiple streams of work effectively. - None Required for Licenses and Certifications. Requirements - Reviews, researches, and makes necessary updates to claims. - Achieves and maintains a clear understanding of all systems, applications, and procedures necessary to identify denial codes, edits, and processing codes. - Communicates with internal and external contacts to provide necessary and accurate information. - Reviews quality audits for correction or routing within 48 hours of receipt. - Researches, investigates, and determines the correct order of benefits for payment. - Analyzes, investigates, resolves problem cases including adjusting previously processed claims. - Executes procedures to recover funds from providers, subscribers, or beneficiaries. - Steps in and assists in any other capacity as deemed necessary. - May complete special projects as assigned by Management. Benefits - Resources to live well and be healthy. - Opportunities for continued learning and skill development. - Support for professional growth. - Engagement in serving local communities. Company Description Blue Cross and Blue Shield of Louisiana performs background and pre-employment drug screening after an offer has been extended and prior to hire for all positions. - Smoke and tobacco-free company properties. - Drug Free Workplace policy.