This job was posted by https://www.kansasworks.com : For more
information, please see: https://www.kansasworks.com/jobs/13438951 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 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 experience -
required.
Thorough knowledge of multiple product lines, contracts, and related
operating policies with preference to FEP, Blue Choice, State of Kansas,
And Interplan Teleprocessing System (ITS) - Preferred.
Thorough knowledge of CSI, Reimbursement Schedules, Ask Oz, ACEs, Clai
