Conduct complex, in-depth analyses of claim payments and their methodology, identifying trends and patterns to ascertain cost avoidance/overpayment recovery opportunities. Apply root cause analysis to design and develop solutions to payment integrity opportunities/issues, and coordinate implementation efforts with internal stakeholders, as well as vendor(s) and providers as applicable. Ensure medical claims, records, and other documentation essential to claims submission and reimbursement are in compliance with state and federal guidelines, provider contracts, BCBSRI policy, national coding guidelines, and industry standards. Detect areas of billing inefficiencies, internal control weaknesses, and noncompliance and provide recommendations for corrective action plans.
ESSENTIAL JOB FUNCTIONS:
QUALIFICATIONS:Minimum Education and Experience:
At Blue Cross & Blue Shield of Rhode Island (BCBSRI), diversity and inclusion are central to our core values and strengthen our ability to meet the challenges of today's healthcare industry. BCBSRI is an equal opportunity, affirmative action employer. We provide equal opportunities without regard to race, color, religion, age, national origin or ancestry, disability, veteran status, sexual orientation, genetic information, sex, gender identity or expression, and any other personal attributes protected by federal, state, or local law. For more information about our commitment to diversity and inclusion, please see our Diversity Report at bcbsri.com/diversityreport.
The law requires an employer to post notices describing the Federal laws prohibiting job discrimination based on race, color, sex, national origin, religion, age, equal pay, disability, veteran status, sexual orientation, and genetic information and gender identity or expression. Please visit http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf to view the "EEO is the Law" poster.
BCBSRI is committed to working with and providing reasonable accommodation to individuals with disabilities. If, because of a disability, you need a reasonable accommodation for any part of our application process, please contact us at (401) 459-1050 for assistance.
During the application process, please allow a minimum of five business days before you contact our office to inquire about the status of your application. If you have any questions regarding your application or during the process, please contact Human Resources by phone at (401) 459-1050 or by email at email@example.com.
Southern New England, Boston, MA, Hartford, CT, Health Data Analyst, RI Health Insurer, Healthcare, Wellness, Provider, Network, Rhode Island, RI, Accredited Record Technician, ART, Certified Medication Technician, Clerical, Coding, Coder, Medical Billing, EMR, Electronic Medical Record, Certified Coding Specialist, CCS, CCS-P, Certified Procedural Coder, CPC
In addition to the standard benefits package you would expect, we also offer: