Job Description
About Blue Cross And Blue Shield Of Minnesota At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming health care. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing. If you are ready to make a difference, join us.
The Impact You Will Have In this role you will be responsible for ensuring healthcare medical coding and reimbursement policies are implemented and integrated in all systems for accurate claims adjudication. This includes analysis of changes to medical code sets to determine impacts to and necessary changes of current policies, assisting with data analysis and reporting needs related to coding policy decisions, and reviewing medical records to validate provider coding. The incumbent will also represent the medical coding team on various Blue Cross project teams.
Your Responsibilities - Conduct in-depth research and analysis of appeals data and processes to identify trends and emerging issues, and recommend best practices for maximum performance.
- Research and recommend resolution and/or prepare written response for provider related coding appeals assuring that federally and state mandated coding rules are followed and that the medical documentation supports such coding.
- Provide recommendations to leadership to modify reference materials and processes that do not fully satisfy regulatory or legal compliance related to coding.
- Provide recommendations to modify materials and processes that do not accurately follow our internal policies and contracted agreements or that have proven to be confusing or ineffective.
- Complete follow-up activities to reflect change for compliance.
- Assist in communicating changes in Blue Cross coding and reimbursement policies to all lines of business, internal business teams and contracted providers.
- Maintain Blue Cross Provider Policy and Procedure Manual relative to coding policy decisions and related reimbursement.
- Serve as a liaison to other divisions/departments (Health Management, Service, Claims) for coding policy and coding/payment issues.
- Directs and coordinates activities of designated coding projects through the project life cycle including the needs assessment, project initiation, design, development and implementation.
- Serve as a knowledge expert related to medical coding.
- Participate as a team member of cross-departmental committees (e.g. Coding and Reimbursement, RICHIE, NAG, I-team).
Required Skills And Experiences - 2+ years' related experience or Bachelor’s degree. All relevant experience including work, education, transferable skills, and military experience will be considered.
- 3 years of relevant health plan or provider office medical coding/claims and/or Business Analyst experience in a healthcare setting applicable to claims/coding.
- At least 1 of the following Certifications: CPC or CCS.
- Incumbent is expected to enroll in continuing education courses to maintain certification.
- Ability to apply critical thinking skills to coding policy interpretation and implementation.
- Ability to work independently; well-organized and able to set priorities with minimal direction.
- Ability to effectively communicate both verbally and in writing.
- Strong PC skills; Excel, Word, PowerPoint and internet based programs.
- Ability to maintain relationships with internal and external stakeholders, coding experts, and others.
Preferred Skills And Experience Compensation And Benefits Pay Range: $67,200.00 - $89,100.00 - $111,000.00 Annual
Pay is based on several factors which vary based on position, including skills, ability, and knowledge the selected individual is bringing to the specific job.
We Offer a Comprehensive Benefits Package Which May Include - Medical, dental, and vision insurance
- Life insurance
- 401k
- Paid Time Off (PTO)
- Volunteer Paid Time Off (VPTO)
- And more
To discover more about what we have to offer, please review our benefits page.
Equal Employment Opportunity Statement Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, gender expression, or any other legally protected characteristic.
Reasonable Accommodation for Job Seekers with a Disability: If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to talent.acquisition@bluecrossmn.com.
All roles require a high school diploma (or equivalency) and legal authorization to work in the U.S.
Blue Cross and Blue Shield of Minnesota and Blue Plus are nonprofit independent licensees of the Blue Cross and Blue Shield Association.
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