Blue Care Network Of Michigan Work Values

Daily Duties at Blue Care Network Of Michigan:

Performed all phases of ad-hoc information requests including research, development, production, and documentation. Confirm with the requestor the nature of the request submitted (question to be answered and data fields required, the data format of the output and the time frame to be included in the data, and the date needed). If the data request included pharmacy data I would confer with a member of the pharmacy department to identify and confirm the appropriate National Drug Code (NDC), therapeutic class code, as well as the brand and generic names of products to be included. Based on this information I would identify and confirm with the requestor the data sources to be used including the appropriate claims detail (i.e., provider types, diagnosis, discharge status and billing codes, etc.) Following consultation and approval by the requestor I would design all queries, determine the appropriate statistically valid sample size (if necessary), extract all data from the appropriate data warehouse tables, clean data as needed, analyze the output, document all steps, prepare and deliver the report. Managed assigned clinical quality projects; participated in the production of the annual Healthcare Effectiveness Data Information Set (HEDIS) report. Participated in the performance of systems validation and documentation as requested. Served as departmental liaison to internal operational committees for Medicare and Medicaid. Processed user applications for access to the BCN web site (Health eBlue) that provided preventive screening status information for the members of the provider's patient panel and allowed provider entry of services provided. The web application was also available to BCN staff such as case managers for reviewing and tracking members' health status. Developed and maintained the Medicare diagnostic and risk mapping table used to document the physicians' annual evaluation of patients' existing medical conditions. Assisted in the compilation of documentation on behalf of the Medical Informatics Department for inclusion in the annual State of Michigan site visit report related to the certification of the organization as a Medicaid contractor. Supported the clinical quality team by preparing sample frames, data collection tools, data entry databases, cleaning, analyzing and preparing ssummary data reports of the annual quality improvement studies as required for both licensing and accreditation of the organization by the State and the National Committee for Quality Assurance. Functioned as part of a 20+ member team in the Medical Informatics Department. The primary functions of the department were to produce the annual Healthcare Effectiveness Data Information Set (HEDIS) for all product lines (Commercial, Medicare and Medicaid). Maintained the data warehouse used to produce the reports, prepare monthly provider report cards, process and approve provider applications for web access to patient level data based on HEDIS measures. Maintained and performed quality control of the datawarehouse table that contained the data on members who were deceased. This table was used throughout the company to assure that mailings did not go out to deceased members or their families and to identify possible fraud and abuse.

What they like about Blue Care Network Of Michigan:

You give high priority to hiring firms with prestige. Market reputation and prestige of a firm may be determined through on-line research, and conversations with individuals working in your target industry. Note that firms "in the public eye" receive a great deal more critical publicity and attention than those operating with more anonymity. So as you assess your employment opportunities, be sure to seek out the positive aspects of the firm's reputation in addition to noting negative publicity the company may have received.

Tags

Vendor management, Grant and progress report writing, Postgres Structured Query Language, Microsoft Access, Microsoft Excel, Microsoft PowerPoint, Microsoft Project Manager, SPSS, Adobe, Small group facilitation

Skills

Technology Solutions, Sales Support, Microsoft Office (Word, Access, Excel, PowerPoint, Project Planner), Postgres Structured Query Language (PSQL) Developer for Oracle 10g, Statistical Package for the Social Sciences (SPSS) version 16, Business Objects, Development of Requests for Proposals, Adobe, Grant and progress report writing, Medical billing coding systems (Current Procedural Terminology (CPT), International Classification of Diseases (ICD-9-CM), Healthcare Common Procedure Coding System (HCPCS)), Excellent Problem Solving Skills, Small group facilitation, Excellent Communication Skills

These are some of the questions we asked our climbers about their experiences with Blue Care Network Of Michigan: