Medical Review Claims Analyst

Job not on LinkedIn

🔥 14 hours ago

🌪️ Kansas, Missouri – Remote

🌪️ Kansas – Remote 🏰 Missouri – Remote

💵 $23 - $29 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

📋 Claims Specialist

🚫👨‍🎓 No degree required

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Blue Cross and Blue Shield of Kansas

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

💼 Consulting

⚕️ Healthcare Insurance

Healthcare • Consulting • Healthcare Insurance

Blue Cross and Blue Shield of Kansas is the largest health insurer in the state of Kansas and operates as a mutual insurance company owned by its policyholders. Governed by a board consisting of 16 Kansans with diverse expertise, the company ensures that the voices of customers and healthcare professionals are included in its operations. With a strong financial foundation, BCBSKS pays over $1 billion in annual claims to healthcare providers and actively contributes more than $140 million to the local economy through payroll and taxes. Headquartered in Topeka, KS, it employs nearly 1,400 individuals across various locations in the state and is part of the Blue Cross Blue Shield Association, which facilitates collaboration among 36 independent Plans nationwide.

📋 Description

• Conduct timely and accurate independent non-clinical reviews of BCBS, National & Special, State, Federal, ITS claims, and CSC inquiries • Respond to internal and external inquiries about contract coverage, coding, and claims payment • Research claim history and identify appropriate guidelines • Escalate non-clinical reviews requiring nurse consultant, management, consultant, or outside review • Format clear and concise questions for higher-level review • Support Marketing, Hotline, CSC, and other internal staff with coding, claim processing, and pricing questions • Maintain current knowledge of coding, contract language, system editing, and pricing guidelines • Identify aberrant provider utilization and refer opportunities for provider education, guideline changes, and system changes • Participate in department and cross-divisional teams • Process claims and inquiries according to contract, corporate, and federal guidelines

🎯 Requirements

• High school diploma or equivalent required • Minimum 3 years' experience in BCBSKS Claims or Customer Service, or minimum 2 years' experience in medical coding and AAPC certification, or minimum 3 years' experience in medical coding • Certified Coder—AHIMA or AAPC within three years of hire required • Must follow URAC standards as required for essential job functions • Self-directed, with ability to make independent decisions and prioritize personal and employee production activities • Strong computer skills with company systems and programs • Ability to maintain productive and professional relationships with multiple cross-departmental and divisional teams • Strong analytical background • Ability to use medical terminology, medical diagnostic and procedure information, ICD-10, CPT, and HCPCS coding accurately • Thorough knowledge of multiple product lines, contracts, and related operating policies • Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment • Must complete pre-employment drug screening, criminal conviction check, employment verifications, and education verification as part of a conditional offer

🏖️ Benefits

• Paid vacation and sick leave • Paid maternity and paternity leave immediately upon hire • Incentive pay program (EPIP) • Health, vision, and 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 and fitness benefits, discounts, and resources • Flexible work environment