[Hiring] CARR Analyst II @BlueCross BlueShield of Tennessee

Role Description

CARR is seeking a Coding Analyst II to support the Facility Coding & Reimbursement Team! This role supports facility coding and reimbursement across all lines of business, including:

• Contract development
• System configuration
• Code maintenance
• Medical policy implementation
• Claim editing
• Provider disputes
• Appeals
• Coding updates
• Claims adjudication

In this position, you will:

• Research complex coding and reimbursement issues
• Evaluate regulatory and industry changes
• Collaborate with Claims, Provider Network Management, Medical Policy, Clinical Coding Review, IT, and Customer Service to support payment accuracy, compliance, and reimbursement solutions

Qualifications

• Experience in facility coding and reimbursement, including inpatient and outpatient payment methodologies
• Experience with claims processing, reimbursement research, regulatory guidance, claims editing, and payment integrity reviews
• Strong analytical and problem-solving skills with the ability to research and communicate complex reimbursement topics
• Knowledge of MS-DRGs, APCs, revenue codes, facility billing requirements, contract reimbursement methodologies, and payer reimbursement systems is strongly preferred

Requirements

• Bachelor's Degree or equivalent work experience required (4 years of professional work experience in a corporate environment)
• 3 years of experience with Medical/Clinical Coding
• Coding certification from a nationally recognized coding organization (i.e. American Academy of Professional Coders-CPC or CPC-H certification, American Health Information Association CCS-P or CCS certification) is required
• If not Coding certified, must be willing to obtain certification within two years of being hired in the position
• Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles and accountability
• Proficient in Microsoft Office (Outlook, Word, Excel, and PowerPoint)
• Must be a team player, organized, and able to handle multiple projects
• Excellent oral and written communication skills
• Strong interpersonal and organizational skills
• Knowledge and understanding of claims, customer service, member benefits, authorization, and reimbursement applications and configuration
• Knowledge and understanding of BlueCross BlueShield of Tennessee and Medicare provider reimbursement methodologies for at least one of the following specialty areas is required: Professional services, Facility services, or Home Health services
• Basic knowledge and understanding of Health Insurance Portability and Accountability Act (HIPAA) standardized claims transaction and medical/clinical

Company Description