Blue Cross and Blue Shield of Nebraska (BCBSNE) is more than just an insurance company; we exist to be there for people in the best and hardest moments of their lives.
Our team is the power behind that promise. And, as the industry rapidly evolves and we seek ways to optimize business processes and customer experiences, there's no greater time for forward-thinking professionals like you to join us in delivering on it!
As a member of Team Blue, you'll find purpose, opportunities and the support you need to build a meaningful career and make a powerful impact in our community.
As a Reimbursement Analyst, you will be a key strategic partner to health network reimbursement and will be directly involved in structuring and maintaining reimbursement for institutional, professional and ambulatory surgical center networks. You will be responsible for researching and reviewing claims for proper coding and billing. You will also perform post payment review and analysis on data related to billing and coding for reimbursement related polices, work with providers to resolve reimbursement issues related to their contracts, educate internal and external customers on appropriate billing and coding practices and policies and analyze data related to billing and coding for reimbursement related polices.
What you'll do:
- Accurately construct, load, audit, maintain, and document all reimbursement schedules for the BCBSNE claims systems.
- Research and analyze claim data for inappropriate billing practices, inappropriate coding, and any other reimbursement methodology concerns. This will include investigation of APR-DRG's, CPT/HCPCS codes, Revenue Codes, ICD-10's, any potential BCBSNE auditor errors, any potential system errors, inappropriate application of benefits, or any other factors deemed necessary to appropriately adjudication claims.
- Create all documentation necessary to record any review of live claims and the resulted actions. Consult with Reimbursement department leadership to determine necessary adjustments prior to full adjudication of the live claims.
- Perform all special claim payment and special billing investigations for all claims types.
- Work collaboratively with Business Analytics, Provider Relations Managers, Special Investigations Unit, and other inter-department teams on a wide variety of reimbursement related projects.
- Provide assistance with any billing, coding, or provider payment concerns that arise from claim audits. Also serve as a subject matter expert regarding network reimbursement.
- Keep abreast of changes to industry standards, coding/billing guidelines, internal medical policy, benefit changes, and reimbursement methodologies.
- Other duties as assigned.
To be considered for this position, you must have:
- Associates Degree in a related field and three (3) years' experience in healthcare. An equivalent combination of education and experience may be substituted for this requirement.
- General understanding of institutional, professional and ambulatory surgery reimbursement methodologies including CPT/HCPCS, RBRVS, APR-DRG's, and EAPG's.
- Intermediate to advanced Microsoft Office skills (Highest priority in Excel).
- Medical Coding Experience.
- The ability to meet or exceed the attendance and timeliness requirements of their departments.
- The ability to work well in a team environment, and be capable of building and maintaining positive relationships with other staff, departments, and customers.
The strongest candidates for this position will also possess:
- Bachelor's Degree in Accounting, Healthcare or other business related field.
- Agile Training.
- Experience in SQL or other programming languages.
- Claims processing training.
Learn more about what makes BCBSNE such an exceptional place to work by visiting NebraskaBlue.com/Careers.
We strongly believe that diversity of experience, perspective and background will lead to a better workplace for our employees and a better product for our customers and members.
Blue Cross and Blue Shield of Nebraska is an Equal Opportunity /Affirmative Action Employer - Minorities/Females/Disabled/Veterans