Business Consultant (Remote)

PURPOSE

The Business Consultant provides expertise in tailored, strategic, and critical work to help design, launch, and execute programs that support initiatives in the changing healthcare environment. Specifically, this position will be part of the Appeals and Grievances Government Programs team and supports the development, implementation, and optimization of business processes and strategic initiatives for the Government Programs Appeals and Grievances function.

Essential Functions

• Provides subject matter expertise in the area of appeals and grievances while acting as a liaison for interdepartmental collaboration to include but not limited to utilization management, claims operations, service operations, payment integrity and compliance.
• Contributes to the effective accomplishment of initiatives tasks and goals.
• Collaborates on the business strategy, thesis, programs and the identification of strategic opportunities.
• Serves as a key liaison between the Appeals and Grievance team and interdisciplinary partners including Claims Operations, Service Operations, Utilization Management, Payment Integrity, and Compliance to improve process efficiency, support regulatory compliance, and strengthen operational performance.
• Works under the direction of the Director, Medical Review and Appeals, the Business Consultant helps drive initiatives that support accurate, timely, and compliant handling of appeals and grievances across Medicare and Medicaid lines of business.

Qualifications

• Education Level: Bachelor's Degree OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.
• Experience: 5 years experience in business development, operational technology support, general business operations and/or consulting experience.
• Preferred Qualifications: Direct experience with appeals and grievances for government programs lines of business in a payor organization.
• Knowledge, Skills And Abilities (KSAs): Understands business goals and priorities. Follows evolving market, industry and consumer trends. Effective communication of complex ideas both verbal and written. Exceptional project management, facilitation and organizational skills. Excellent relationship management skills. Strategic thinker, problem solver, and a collaborator who can drive engagement and discussions. Significant experience with MS Office (Excel, PowerPoint, Word).

Salary Range

The salary range for this position is $88,848 - $176,462. Salary range disclaimer: The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location.

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.