Medical Review Claims 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.
Dynamic Work Environment: Collaborate with a team of passionate and driven individuals.
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
$23.58 – $29.40 hourly
Non-Exempt 12
Blue Cross and Blue Shield of Kansas offers excellent competitive compensation with the goal of retaining and growing talented team members. The compensation 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 wages 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 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 identifying when a non-clinical review should be elevated to a higher level of review, i.e., nurse consultant, management, consultants.
Responsible for researching history, identifying appropriate guidelines, and formatting clear concise question(s) for claims needing nurse, management, or outside consultant review.
Responsible for providing support to internal staff (i.e., Marketing, Hotline, CSC), regarding questions about coding, claim processing, and pricing issues.
Responsible for maintaining current knowledge regarding coding, contract language, system editing, and pricing guidelines.
Responsible for identifying areas of aberrant utilization for provider education, guideline, and system changes.
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 in order 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 certification with at least 2 years of coding experience or at least 3 years of medical coding experi
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