PIO Vendor Manager at Florida Blue

, , United States -

Full Time

Start Date

Immediate

Expiry Date

15 Oct, 26

Salary

126100.0

Posted On

17 Jul, 26

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Vendor Management, Program Design, Contract Adherence, SLA Monitoring, Performance Reporting, Claims Adjudication, Root Cause Analysis, Stakeholder Management, Project Management, Financial Analysis, Strategic Planning, Corporate Compliance

Industry

Insurance

Description

JOB SUMMARY Accountable for providing leadership, coordination and reporting for final pass claims editing vendor program. The key responsibilities include creating the integrated Program plan to carry out the goals and strategy and managing and oversight of the program design and execution. Establishing integration and coordination processes with other programs, vendors and initiatives to monitor progress, address scope, and prioritizations. Essential Functions Vendor Management- Monitoring and Compliance * Responsible for the development and ongoing, end-to-end management/ oversight of the program * Responsible for vendor relationship management, including contract adherence, payment reconciliation, performance, and continuous improvement * Ensure vendor completion of corporate compliance requirements, training and annual due diligence requirements * Responsible for program performance, including vendor performance and adherence to established SLA’s, ROI, etc. Act as direct liaison between the vendor and the business stakeholders * Invoke corrective action plans for program or vendor for missed targets * Responsible for all established processes associated with the program: e.g. IT/Vendor connectivity, transmission of data, claims adjudication processes, contract adherence, etc. * Responsible for continuous improvement of the program Program design * Responsible for program design documentation and reporting of vendor performance (operational, compliance, contractual). * Support engagement of new vendors to support strategic design of the program (i.e., alignment of final pass editing with any future editing programs). * Responsible for integrating with the vendor and operational areas to support new and improved processes. * Coordinate with all levels of management and departments internal and external to the Payment Integrity Office (PIO). * Provide vendor education to internal areas * Manage and lead implementation of multiple components of evolving claim edit concepts and opportunities through research and analysis processes * Translate corporate strategies into tactical application for vendor execution Reporting * Support evaluation and analysis of vendor financial and operational performance. Development of Vendor scorecards * Coordinate regular vendor/ internal meetings to facilitate a venue for sharing and monitoring operational performance, service level agreements, and process improvement opportunities. * Coordinates with all impacted business areas to develop and maintain appropriate reporting; identifying metrics that will reflect true vendor and program performance * Manage multiple complex issues and projects simultaneously * Work collaboratively with other areas of Payment Integrity, Care Management, Medical Operations, Care Delivery, and Claims. * Coordinate Program reporting with vendor and appropriate areas within the organization Project/Root Cause * Act as a liaison with internal business partners for escalated issues related to the vendor REQUIRED QUALIFICATIONS * 5+ years related work experience in leading and managing external business partner vendor relationships * Related Bachelor’s degree or additional related equivalent work experience * Experience leading and managing external business partner vendor relationships * Experience managing the integration of new processes into complex processing systems * Experience in developing education materials * Excellent oral and written communication skills * Experience designing, implementing, managing and evaluating programs and projects PREFERRED QUALIFICATIONS * Seasoned written and verbal communication skills which includes demonstrated ability to facilitate training. * Knowledge of Florida Blue health and ancillary products and systems * Knowledge of claims processing, payment policy, and coding concepts General Physical Demands Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally. Physical/Environmental Activities Must be able to travel to multiple locations for work (i.e. travel to attend meetings, events, conferences). Occasionally What We Offer: As a Florida Blue employee, you will be at the heart of GuideWell’s vision – to lead the nation in transforming health through compassionate, connected, and technology-enabled care that delivers personalized value and empowered living. To support your wellbeing, comprehensive benefits are offered. As an employee, you will have access to: * Medical, dental, vision, life and global travel health insurance; * Income protection benefits: life insurance, short- and long-term disability programs; * Leave programs to support personal circumstances; * Retirement Savings Plan including employer match; * Paid time off, volunteer time off, 10 holidays and 2 well-being days; * Additional voluntary benefits available; and * A comprehensive wellness program Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for intern, part-time and seasonal employees may differ. To support your financial wellbeing, we offer competitive pay as well as opportunities for incentive or commission compensation. We also conduct regular annual reviews with pay for performance considerations for base pay increases. Annualized Salary Range: $77,600 - $126,100 Typical Annualized Hiring Range: $77,600 - $97,000 Final pay will be determined with consideration of market competitiveness, internal equity, and the job-related knowledge, skills, training, and experience you bring. We are an Equal Employment Opportunity employer committed to cultivating a work experience where everyone feels like they belong and can perform at their best in pursuit of our mission. All qualified applicants will receive consideration for employment.

Responsibilities

Lead and coordinate the final pass claims editing vendor program, ensuring contract adherence and operational performance. Manage vendor relationships, program design, and the integration of new processes into complex systems.