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BlueCross BlueShield of South Carolina · Georgia, GA, United States
This is a full-time remote position . You will work an 8-hour shift scheduled during our normal business hours of 8 a.m. – Must be able to travel up to 3-5 days a week. There may be some weekday and weekend overnight traveling involved. May include travel outside of the assigned areas of Alabama, Georgia, or Tennessee as necessary.
Communicates/educates providers on issues such as Medicare coverage, utilization statistics, documentation and medical review by use of written advisories, reports, letters, and telephone contacts.
Documents all provider contacts/communications in provider tracking system.
Conducts formal conference calls and/or in-person educational visits with providers that are consistently over utilizing services, on progressive corrective action, or have unacceptable denial rates and/or error rates under the medical review program.
Conducts coverage and documentation workshops for provider staff (Medicare providers and physicians' staff).
Researches, composes, and coordinates the preparation of all regulatory based provider education materials.
Performs analysis of effective reports to determine actions to be taken regarding medical reviewed its/audits.
Works with medical review department and provides input regarding actions taken in response to provider billing practices.
Participates in the medical review process and inter reviewer reliability (IRR) studies.
Assists in training of medical review associates regarding coverage and medical review process.
Required
If LPN, graduate of accredited School of Licensed Practical Nursing; if LVN, graduate of accredited School of Licensed Vocational Nursing; if RN, graduate of approved School of Nursing.
Required Work
Knowledge of medical terminology and disease processes. Demonstrated proficiency in word processing and spreadsheet software. Effective customer service, organizational, and presentation skills. Ability to handle confidential or sensitive information with discretion.
Required Software and Tools: Microsoft Office.
Active LPN or LVN licensure in state hired, OR, active compact multistate LPN license as defined by the Nurse Licensure Compact (NLC), OR active RN licensure in state hired OR active compact multistate RN license as defined by the Nurse Licensure Compact (NLC).
3 years of provider relations and Medicare experience. IRF (Inpatient Rehabilitation Facility) education consultant experience.
Knowledge of claims processing software. Preferred Software and Other Tools: Working knowledge of Microsoft Access or other database software.
Subsidized health plans, dental and vision coverage
~401k retirement savings plan with company match
~ Life Insurance
~ On-site cafeterias and fitness centers in major locations
~ After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.
BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.
We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.
help@bcbssc.
Details
| Company | BlueCross BlueShield of South Carolina |
| Location | Georgia, GA, United States |
| Type | FULL TIME |
| Niche | healthcare |