Medical Policy Project Analyst

We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally and serve our local communities. We invite you to apply for a career with Blue Cross.

Residency in or relocation to Louisiana is preferred for all positions.

This position is mostly remote with the expectation to come into the Baton Rouge, Louisiana office as needed.

POSITION PURPOSE

This position will handle multiple complex enterprise projects and assignments utilizing strong project management, analytical and technical skills. This position will work closely with the Manager of Medical Policy and Medical Appeals to effectively manage and coordinate implementation of projects as defined by the Medical Policy unit work initiatives and goals.

NATURE AND SCOPE

• This role does not manage people
• This role reports to this job: MANAGER, MEDICAL POLICY
• Necessary Contacts: n order to effectively fulfill this position the incumbent must be in contact with:
  
  Medical Director, departmental management in Provider Reimbursement, Provider Audit, Medical Management, I.T., BCBSLA Network physicians, national physician specialty organizations, American Medical Association, Centers for Medicare and Medicaid Services (CMS/HCFA), Louisiana Medicare, American Academy of Professional Coders and subscribers, and the BCBSA Medial Policy Unit.

QUALIFICATIONS

Education

• Bachelor's in nursing or a related health care field is required
• In lieu of a Bachelor's degree a current, unrestricted RN license in the state of Louisiana and/or in the required jurisdictions, or where services are provided can be used.
• In lieu of a Bachelor's degree a current, unrestricted LPN license in the state of Louisiana and/or in the required jurisdictions, or where services are provided to practice in Louisiana as well as two years of related experience can be used.
• In lieu of a Bachelor's degree four years of directly related research, analysis and application of medical coding experience can be used.

Work Experience

• 7 years of experience to include research, analysis, and application of CPT, HCPCS, CDT and ICD-10-CM coding is required
• The 7 years of experience must include at least some experience in each of the following areas: provider appeals, managed care, clinical editing concepts, disease processes, and/or medical policy procedures.
• Demonstrated experience with provider and/or payor healthcare claims systems is required
• Experience verifying healthcare claims is preferred
• Leadership or supervisory experience is preferred

Skills and Abilities

• Must be able to properly assign appropriate procedure and diagnosis codes to highly technical and complex coverage eligibility criteria.
• Must be able to analyze and compare elements of complex technology assessments.
• Must possess working knowledge of MS Office; Word, Excel and Access and be able to perform at an intermediate level.
• Excellent organization and analytical skills with the ability to multi-task.

Licenses and Certifications

• Certified professional coding credentials for CPT, HCPCS, and/or ICD-10-CM medical coding systems is preferred upon hire but must be attained within 90 days of moving into the job.
• Additional coding certification is preferred

ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS

• Provides research analysis and support for specific projects, implementations, on going maintenance and enhancements of multiple complex enterprise wide systems to continue to develop the Medical Policy Strategy.
• Provides medical policy analysis to assign appropriate coding, designate claims processing scenarios to ensure accurate claims payment and interacts with processing staff/ or manages enterprises to coordinate on-going up to date claims payment instruction.
• Defines data, business and user requirements and translates into detailed system requirements and plans to implement and support ongoing Medical Policy activities.
• Prepares reports to management defining problems, evaluation and possible solution to system issues to monitor impact and ensure quality of implementation.
• Coordinates and participates in user groups and other committees as needed to act as a subject matter expert to provide input from Medical Policy Strategies and Goals.

Additional Accountabilities and Essential Functions
The Physical Demands described here are representative of those that must be met by an employee to successfully perform the Accountabilities and Essential Functions of the job. Reasonable accommodations may be made to enable an individual