Blue Cross Blue Shield of Michigan
Analyst (Healthcare)
Responsible for assisting and supporting management in the evaluation, recommendation, establishment, implementation and analysis of new and improved production workflows, work processes for systems, reporting and new products/programs to improve customer service levels and overall quality.
Clinical Editing Analyst Description
This position is primarily responsible for the coordination of activities within the clinical editing unit. This area is responsible for the development, implementation and decision-making related to the clinical editing software utilized by the health plan to determine the appropriateness of billing and reimbursement within said parameters. These parameters include clinical edits, multi-line surgery claims and daily limit processing (dlp), as well as related provider appeals. There is an emphasis on report analysis to determine appropriate payment levels based on standard billing practices and medical coding standards. Related technical expertise is available and is provided to internal departments.
Department Preferred Qualifications:
· Associate's degree or two years of college preferred with an area of concentration in business, information systems, or a health care related field. Bachelor's degree preferred
· ICD 10-CM and CPT courses required; may consider two years' experience with these manuals in lieu of classes
· Coding certification (e.g., CPC, CCS, CCS-P, or RHIT)
· Minimum of four years in any combination of the following: Billing and coding experience (preferably in a comprehensive surgical center or facility), Claims resolution (including adjudication, coding, thorough analysis and problem-solving)