Medical Review Claims Analyst

Blue Cross Blue Shield of Kansas • Topeka, KS • 1d ago

This job was posted by https://www.kansasworks.com : For more information, please see: https://www.kansasworks.com/jobs/13438950 The Medical Review Claims Analyst is responsible and accountable for timely and accurate non-clinical reviews of Blue Cross and Blue Shield, National & Special, State, Federal, ITS claims and CSC inquiries to support corporate timeline goals. Responsible for accurate and timely responses to internal and external inquiries involving requests for explanation of contract coverage, coding, and claims payment. Responsible for identifying aberrant provider activity and opportunities for provider education and refer for appropriate intervention.

\"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 effectivelywith 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

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