Job Information
Blue Cross Blue Shield of Kansas Medical Review Claims - CXT Analyst in Topeka, Kansas
This job was posted by https://www.kansasworks.com : For more information, please see: https://www.kansasworks.com/jobs/13180277
The Medical Review Claims CXT Analyst is responsible and accountable for timely and accurate maintenance of Claims XTen (CXT) edits. Responsible for maintaining the CXT master spreadsheet. Responsible for assisting the claims analysts with 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, claims payments, and CXT editing. 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.
What youll do
Responsible for assisting with the creation of CXT change requests.
Responsible for maintaining the CXT master spreadsheet.
Responsible for regular CXT edit testing.
Responsible for assisting with the claim analyst team with 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 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 CXT processing.
Responsible for maintaining current knowledge regarding coding, contract language, system editing, and pricing guidelines.
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, Claims XTen, Imaging, BlueConnect, and Outlook preferred.
CPC certified or obtain certification by American Academy of Profession l Coders within three years of hire.
Physical Requirements:
- 90-100% sedentary work setting using a computer.
Benefits & Perks
Base pay is only one component of your competitive Total Rewards package
Incentive pay program (EPIP)
Health/Vision/Dental insurance
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