Provider Reimbursement Assistant
Blue Cross Blue Shield Kansas

Blue Cross and Blue Shield of Kansas is looking to add to our Medical Economics team and has an opportunity for a Provider Reimbursement Assistant. This position supports provider contracting Reimbursement policy and audits for both professional and institutional providers. The position is responsible for auditing data report for duplicate claims and other identified claim reimbursement issues. The position assists with the coordination, implementation, and maintenance of various specialized reimbursement policies.

"This position is eligible to work remotely (8 or less days a month onsite) or hybrid (9 or more days a month onsite) 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?

• Family Comes First: Total rewards package that promotes the idea of family first for all employees; including paid time off and family first leave.
• Make a Positive Impact: Your work will directly contribute to the health and well-being of Kansans.
• Stability: 80 years of commitment, compassion, and community
• Inclusive Work Environment: We pride ourselves on fostering a diverse and inclusive workplace where everyone is valued and respected.

Compensation

$22.31 - $26.50
Non-exempt Grade 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

• Conducts provider contract reimbursement and policy audits, claims system audits, provider entry system audits, ITS reimbursement and policy audits, audits of manual claims processing functions and other special reviews in accordance with the reimbursement program audit plan.
• Assists with performing professional claim recovery activity as related to the identification of potential claim adjustments such as for duplicate claims.
• Runs data reports for verification and tracking of the quality based reimbursement program (QBRP) incentives paid.
• Assist with professional reimbursement activities related to proper MAP levels for services provided by facilities and healthcare professionals. Utilize DB2 or QMF to run reports to assist with and develop technical studies, analyses and fiscal impacts that serve as a focal point in the presentation of pricing and methodologies.
• Submission and follow through of claims to the adjustment unit.
• Assists with calculating and updating factors and amounts for routine pricing updates for providers. Ensures accurate and timely implementation of updates.

What you need

• High school graduate or equivalent required.
• Strong computer skills to operate effectively with company systems and programs is required.
• Ability to learn and become proficient in working with SQL, QMF for workstation, DB2, TSO, PES, Provider Suites inquiry, Schedules Inquiry, BlueECM claims, is required.
• Understanding of provider claim coding data ICD 10 and CPT is preferred. This includes knowledge of facility and professional procedure coding and nomenclature. Also, a broad general knowledge of medical terminology, professional protocol, medical economics, and business practices and procedures of professional and institutional providers physician office and hospital outpatient setting.
• Must have excellent written and oral communication skills, with the ability to convince and defend the reasonability of research analyses, findings, and process designs to a wide array of both technical and non-technical persons.
• Ability to make decisions using independent judgment and creativity to resolve issues and overcome roadblocks.
• Must be proficient at advancing multiple projects simultaneously and prioritizing activities based on immediate business needs.

Bonus if you have

• Bachelor's degree in finance, Accounting, Mathematics, Statistics, Risk Management, Economics, Health Care or related degree preferred.
• 2 years reimbursement and/or claims processing experience preferred.
• Experience developing fiscal impacts, financial modeling and analysis and analyzing or auditing financial data is preferred.

Benefits & Perks

• Base pay is only one component of your competitive Total Rewards package:
  • Incentive pay program (EPIP)
  • Health/Vision/Dental insurance
  • 6 weeks paid parental leave for new mothers and fathers
  • Fertility/Adoption assistance
  • 2 weeks paid caregiver leave
  • 5% 401(k) plan matching
  • Tuition reimbursement
  • Health & fitness benefits, discounts and resources

Posting Close Date

Pay Rate Type
Hourly

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