Medical Review Claims - Guide Analyst
Blue Cross and Blue Shield of KansasAbout the role
“This position is eligible to work onsite, remote or hybrid (9 or more days a month on site) in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment.”
Are you ready to make a difference? Choose to work for one of the most trusted companies in Kansas.
Why Join Us
Make a Positive Impact: Your work will directly contribute to the health and well-being of Kansans.
Family Comes First: Total rewards package that promotes the idea of family first for all employees.
Professional Growth Opportunities: Advance your career with ongoing training and development programs.
Stability: 80 years of commitment, compassion and community
Flexibility: options to work onsite, hybrid or remote available
Balance: paid vacation and sick leave with paid maternity and paternity available immediately upon hire
Compensation
Non-Exempt 12
$23.00 - $27.30 hourly
Blue Cross and Blue Shield of Kansas offers excellent competitive compensation with the goal of retaining and growing talented team members. The salary range for this role is a good faith estimate, it is estimated based on what a successful candidate might be paid. All offers presented to candidates are carefully reviewed to ensure fair, equitable pay by offering competitive salaries that align with the individual's skills, education, experience, and training. The range may vary above or below the stated amounts.
What you’ll do
Responsible for creation and maintenance of all clinical and non-clinical internal guides/desk processes.
Receive and prepare guides and guide change requests for regularly scheduled guide team meetings.
Responsible for maintaining the guide master spreadsheet.
Responsible for making sure all clinical guides meet URAC standards.
Responsible for assisting with the claim analyst team with independent non-clinical review of claims and inquiries using contracts, medical policies, internal guides, and desk process.
Ensure claims and inquiries are processed timely and accurately according to contract, corporate, and federal guidelines.
Responsible for researching history, identifying appropriate guidelines, and formatting clear concise question(s) for claims needing nurse, management, or outside consultant review.
Responsible for maintaining current knowledge regarding coding, contract language, system editing, and pricing guidelines.
Participates in department and cross-divisional teams.
Must follow URAC standards as required for essential job functions.
What you need
Knowledge/Skills/Abilities:
Must be able to comply with and implement corporate information security policies, standards, and guidelines relative to access control.
Must be self-directed with the ability to make independent decisions and prioritize personal and employee production activities.
Must have strong computer skills to operate effectively with company systems and programs.
Proficient in Excel, WORD, OneNote, and other department used systems.
Must be able to maintain a productive and professional relationship with multiple cross departmental and divisional teams.
Must be able to maintain an excellent record of attendance.
Must have a strong analytical background.
Must be able to use medical terminology/medical diagnostic and procedure information, ICD-10, CPT, HCPCS coding to accurately review and complete claims activity.
Education and Experience:
High school graduate or equivalent, required.
At least three years of BCBSKS Claims or CSC experience AND/OR American Academy of Professional Coders cert
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