Medical Review Claims Analyst in Topeka, Kansas, United States

Job Information

This job was posted by https://www.kansasworks.com : For more information, please see: https://www.kansasworks.com/jobs/13183888

What youll 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

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.

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, Claims XTen, Imaging, BlueConnect, and Outlook preferred.
CPC certified or obtain certification by American Academy of Professional Coders within three years of hire.

Benefits & Perks

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