Teams at Arkansas Blue Cross and Blue Shield

Prepare, analyze, and review financial statements for accuracy and GAAP compliance. Perform journal entries, account reconciliations, general ledger maintenance, and support financial audits. Assist with special projects, prepare supporting financial data, and provide coaching to less experienced accountants.

Performs utilization management and clinical reviews for inpatient, outpatient, surgical, diagnostic, and out-of-network services. Evaluates medical necessity using evidence-based criteria, clinical guidelines, policies, mandates, and standards. Collaborates with providers and internal teams to promote quality, appropriate care, cost effectiveness, accessibility, and patient safety. Documents determinations, manages review queues and calls, maintains regulatory compliance, and applies nursing judgment to support healthcare service decisions.

Support implementation, configuration, and optimization of Epic Payer Platform to enable bidirectional clinical and administrative data exchange with provider partners. Configure applications, onboard and test integrations, monitor data quality and mapping, troubleshoot issues, develop documentation and training, and support workflows such as prior authorization, claims, risk adjustment, and HEDIS reporting to improve operations and member outcomes.