Job Listing
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| Job ID: 14038975 |
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| Job Location: |
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| How to Apply: | To see employer contact information, log in or register. |
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| Job Title: | Senior Medical Policy Implementation Consultant |
| Work Type: | Work Days: Work Vary: Yes , Shift: Other, Hours Per Week: 40, Work Type: Regular |
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| Salary Offered: | Unspecified |
| Benefits: | 401(k) or other retirement, Child Care, Dental Insurance, Health Insurance, Holidays, Sick Leave or PTO, Vacation or PTO |
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| Physical Required: | Unspecified |
| Drug Testing Required: | Unspecified |
| Education Required: | High School Diploma/GED |
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| Experience Required: | Unspecified |
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| Required Skills: | Please see the job description for information about required job skills. |
| Preferred Skills: |
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| Job Description: |
About Blue Cross
Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.5 million members. We're committed to reinventing health care to improve health for our members and the community. We hope you'll join us.
How is This Role Important to Our Work?
This position a key member of the team that develops and implements medical policies for Blue Cross. The incumbent will be responsible for ensuring that medical policy issues are circulated to internal partners of the company at several stages before final implementation. The incumbent will be part of a team that ensures policies are implemented and integrated with all systems to ensure accurate claims' processing. This will include reviewing and applying new codes to the medical policies, developing quality improvement processes for medical policy implementation, and assisting with data reporting needs, as they pertain to the policy decision making process. The incumbent will also organize communication of medical policy changes and serve as a liaison, within the Integrated Health Management division, for communication of medical policy issues. The Senior Medical Policy Implementation Consultant serves as a resource to other members of the Medical Policy team.
A Day in the Life:
Present and provide implementation input to key medical policy committees: Medical and Behavioral Health Policy Committee, Coverage Committee, and Operational committees as assigned for example, Coding and Reimbursement Committee, and Medical Policy Prep Committees
Prepare final policy documents and tools for implementation.
Implement medical policies-integrates with all systems to ensure accurate claims processing.
Assure that changes in Blue Cross medical policies are communicated to all lines of business, including Medicare, and others as needed.
Research and apply appropriate and regular updates of CPT, HCPCS, and ICD-9/ICD-10 coding to the medical policies.
Maintain Blue Cross's intranet and internet medical policy databases with current policy decisions and coding.
Produce standard reports and assist in the analysis and impact of these reports as they relate to policy implementation process.
Serve as a liaison to other divisions (e.g., Network Management, Account Management, and Service) for medical policy issues.
Research issues on an ad hoc basis to determine coverage status of other health plans, FDA approval status; this may also require limited research of evidence-based literature.
Lead work groups as needed.
Lead projects that support Medical Policy Department and/or Medical Affairs Department.
Serve as a subject matter expert to team members and BCBSMN.
Nice to Have:
Bachelor's orMasters degree in a health-related field, such as nursing.
Knowledge of claims processing
Required Skills and Experiences:
6+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.
Ability to apply critical thinking skills to medical policy interpretation and implementation.
Ability to work independently; well-organized and able to set priorities with minimal direction.
Ability to effectively communicate both verbally and in writing.
Strong PC skills; Excel, PowerPoint, Visio, Word, and internet based programs.
Ability to develop and work on several projects at one time in a fast paced environment.
Ability to maintain relationships with internal and external stakeholders, clinicians, and others.
Project management experience.
Demonstrated positive professionalism in all work-related behaviors as demonstrated by adaptability, contributing to team success, customer focus, strong communication, and efficiently managing work.
Experience mentoring either in 1:1 relationship with a new hire or by sharing best practices and skills with peers and team as a whole.
Make A Difference
Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, gender expression, or any other legally protected characteristic.
Reasonable Accommodation for Job Seekers with a Disability: If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to talent.acquisition@bluecrossmn.com.
All roles require a high school diploma (or equivalency) and legal authorization to work in the U.S.
Blue Cross and Blue Shield of Minnesota and Blue Plus are nonprofit independent licensees of the Blue Cross and Blue Shield Association.
Blue Cross and Blue Shield of Minnesota is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, or any other legally protected characteristic.
Refer to ID 79116728 when applying |
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