Reviewer II, Medical

🔥 0 minutes ago

🏈 Alabama, North Carolina, +1 more states – Remote

🏈 Alabama – Remote 🌲 North Carolina – Remote 🌴 South Carolina – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

🔍🏥 Medical Reviewer

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BlueCross BlueShield of South Carolina

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1946

⚕️ Healthcare Insurance

💸 Finance

Healthcare Insurance • Insurance • Finance

BlueCross BlueShield of South Carolina is a leading health insurance provider that offers a variety of health plans, including individual and family plans, Medicare options, and group health plans. The organization focuses on providing coverage and resources for members, employers, and healthcare providers, ensuring access to quality healthcare services. With a commitment to promoting healthier lifestyles and supporting community health, BlueCross BlueShield of South Carolina plays a vital role in the healthcare landscape of the region.

📋 Description

• Perform medical claim reviews for claims requiring preauthorization or appeals • Determine medical necessity and appropriateness for coverage and reimbursement • Document medical rationale for payment or denial of services • Educate staff on medical reviews, coverage determinations, and coding procedures • Participate in quality control activities

🎯 Requirements

• Associate's in a job related field • Active RN licensure in state hired, OR, active compact multistate RN license as defined by the Nurse Licensure Compact (NLC) • 2 years clinical experience • Working knowledge of word processing software • Ability to work independently, prioritize effectively, and make sound decisions • Good judgment skills • Demonstrated customer service and organizational skills • Demonstrated oral and written communication skills • Analytical or critical thinking skills • Ability to handle confidential or sensitive information with discretion • Microsoft Office proficiency

🏖️ Benefits

• 401(k) retirement savings plan with company match • Subsidized health plans, dental and vision coverage • Life insurance • Paid Time Off (PTO) • Nine paid holidays • On-site cafeterias and fitness centers in significant locations • Wellness programs and a healthy lifestyle premium discount • Tuition assistance • Service Recognition