CARR Analyst II

🔥 2 minutes ago

🎸 Tennessee – Remote

🎸 Tennessee – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

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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 reimbursements • Research and prepare coding and reimbursement policies, procedures, and billing guidelines • Coordinate data collection and administrative functions for coding, reimbursement, and billing changes • Advise corporate committees, workgroups, and sub-workgroups on coding, reimbursement, and billing issues • 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 all lines of business, including 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

• 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 AHIA CCS-P/CCS • If not coding certified, willingness to obtain certification within two years of hire • Experience with facility coding and reimbursement, including inpatient and outpatient payment methodologies • Experience with claims processing, reimbursement research, regulatory guidance, claims editing, and payment integrity reviews • Knowledge of MS-DRGs, APCs, revenue codes, facility billing requirements, contract reimbursement methodologies, and payer reimbursement systems strongly preferred • Ability to research and communicate complex reimbursement topics • Ability to work independently with minimal supervision or in a team environment • Proficient in Microsoft Office, including Outlook, Word, Excel, and PowerPoint • Organized and able to handle multiple projects • Excellent oral and written communication skills • Strong interpersonal and organizational skills • Knowledge of claims, customer service, member benefits, authorization, and reimbursement applications and configuration • Knowledge of BlueCross BlueShield of Tennessee and Medicare provider reimbursement methodologies for at least one specialty area: Professional services, Facility services, or Home Health services • Basic knowledge of HIPAA standardized claims transaction and medical/clinical coding • Sponsorship is not available for this role

🏖️ Benefits

• Remote work / remote-first organization • Possible relocation assistance if residence in Chattanooga, TN is required • Training opportunities • Use of AI-enabled tools supported by workflows, templates, and policies