Job Information
Blue Cross Blue Shield of Minnesota Senior Policy Reimbursement Implementation Consultant in Eagan, Minnesota
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 is responsible for ensuring that reimbursement policies are implemented and integrated with all systems to ensure accurate claims' processing. This will include reviewing and applying new codes to the reimbursement policies, developing quality improvement processes for policy implementation, and assisting with data reporting needs, as they pertain to the reimbursement policy decision making process. Additionally, this role will organize communication of reimbursement policy changes and issues. This position will also serve as a support resource within the division and within the reimbursement policy team. A Day in the Life: Implement and measure policies and integrate with all systems to ensure accurate claims processing. Assure that changes in policies are communicated to all lines of business. Research and apply appropriate and regular updates of CPT, HCPCS, and ICD-9/ICD-10 coding to the policies. Prepare final policy documents and tools for implementation. Present and provide implementation input to policy committees and meetings. Maintain and document system edits, process workflows and process documentation. Maintain Blue Cross external and internal 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 reimbursement policy implementation process. Serve as a subject matter expert to team members and workgroups. Support the reimbursement policy team to solution for reimbursement policy issues and overall policy strategy as needed. 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 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, including 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 build and 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, skillful communication, and efficiently managing work. Strong documentation and workflow process skills. Experience with measuring and monitoring plans. Nice to Have: Bachelor's and/or master's degree in a clinical or health-related field with 6 years' experience working in a health care environment. End to end claims process experience. 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 dipl ma (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.