Medical Review Claims Analyst

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. Paid vacation and sick leave with paid maternity and paternity available immediately upon hire Professional Growth Opportunities: Advance your career with ongoing training and development programs. Dynamic Work Environment: Collaborate with a team of passionate and driven individuals in a work environment that promotes flexibility. Trust and Stability: Work for one of the most trusted companies in Kansas with over 80 years of commitment, compassion and community. Inclusive Work Environment: We pride ourselves on fostering a workplace where everyone is valued and respected. Benefits & Perks Base compensation 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 401(k) plan matching up to 5% Tuition reimbursement Health & fitness benefits, discounts and resources Job Summary 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. Work Location This position is eligible to work remotely, hybrid or onsite in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment. 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. Education High school diploma or equivalent required Experience Minimum 3 years' experience in BCBSKS Claims or Customer Service required or Minimum 2 years' experience in medical coding and AAPC certification required or Minimum 3 years' experience in medical coding required Licenses and Certifications Certified Coder-AHIMA or AAPC within three years of hire required Travel No travel Knowledge, Skills and Abilities Must be self-directed with the ability to make independent decisions and prioritize personal and employee production activities. Must have strong computer skills to operate effectively with company systems and programs. Must be able to maintain a productive and professional relationship with multiple cross departmental and divisional teams. 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. 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). Compensation $23.58 hourly - $29.48 hourly 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. Our Commitment to Connection and Belonging At Blue Cross and Blue Shield of Kansas, we are committed to fostering a culture of connection and belonging, where mutual respect is at the foundation of our workplace. We provide equal employment opportunities to all individuals, regardless of race, color, religion, belief, sex, pregnancy (including childbirth, lactation, and related medical conditions), national origin, age, physical or mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information (including characteristics and testing), military or veteran status, family or parental status, or any other characteristic protected by applicable law. Blue Cross and Blue Shield of Kansas conducts pre-employment drug screening, criminal conviction check, employment verifications and education as part of a conditional offer of employment.