CARR Analyst II

🔥 14 hours ago

🎸 Tennessee – Remote

🎸 Tennessee – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 10%

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.

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BlueCross BlueShield of Tennessee

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

Founded 1952

🏥 Healthcare

💼 Consulting

🛡️ Insurance

Healthcare • Consulting • Insurance

BlueCross BlueShield of Tennessee is a leading health plan provider in Tennessee, serving 3. 4 million members. The company is committed to creating a workforce where everyone is valued, respected, and part of the team, emphasizing diversity and inclusion. They offer a range of career opportunities, including internships through their BlueBridge program, enabling new professionals to transition from college to work. BlueCross BlueShield of Tennessee also focuses on providing exceptional customer service and community care, striving to make a difference in the healthcare industry. It is an independent licensee of the Blue Cross Blue Shield Association and a qualified health plan issuer in the Health Insurance Marketplace.

📋 Description

• Research, design, analyze, recommend, implement, resolve problems, maintain, and coordinate coding and reimbursement activities • Research and prepare coding and reimbursement policies, procedures, and billing guidelines • Coordinate data collection and administrative functions for coding, reimbursement, and billing changes • Advise on coding, reimbursement, and billing issues through corporate committees and workgroups • Assist in developing educational materials for staff training • Provide coding consultations for company administrative functions and reviews • Review, prioritize, prepare, and present recommended code-editing changes • Support facility coding and reimbursement across contract development, system configuration, code maintenance, medical policy implementation, claim editing, provider disputes, appeals, coding updates, and claims adjudication • Research complex coding and reimbursement issues and evaluate regulatory and industry changes • Collaborate with Claims, Provider Network Management, Medical Policy, Clinical Coding Review, IT, and Customer Service to support payment accuracy, compliance, and reimbursement solutions

🎯 Requirements

• Experience in facility coding and reimbursement, including inpatient and outpatient payment methodologies • Experience with claims processing, reimbursement research, regulatory guidance, claims editing, and payment integrity reviews • Strong analytical and problem-solving skills with ability to research and communicate complex reimbursement topics • Knowledge of MS-DRGs, APCs, revenue codes, facility billing requirements, contract reimbursement methodologies, and payer reimbursement systems strongly preferred • No sponsorship available • Bachelor's Degree or equivalent work experience required; equivalent experience is defined as 4 years of professional work experience in a corporate environment • 3 years of experience with Medical/Clinical Coding • Coding certification from a nationally recognized coding organization required, such as AAPC CPC/CPC-H or AHIMA CCS-P/CCS; if not certified, must obtain certification within two years of hire • Ability to work independently with minimal supervision or in a team environment • Proficiency in Microsoft Office (Outlook, Word, Excel, PowerPoint) • Ability to handle multiple projects • Excellent oral and written communication skills • Strong interpersonal and organizational skills • Knowledge of claims, customer service, member benefits, authorization, reimbursement applications, and configuration • Knowledge of BlueCross BlueShield of Tennessee and Medicare provider reimbursement methodologies in at least one specialty area: Professional, Facility, or Home Health services • Basic knowledge of HIPAA-standardized claims transactions and medical/clinical coding