Coding Admin Analyst

Blue Cross and Blue Shield of Nebraska (BCBSNE) is more than just an insurance company; we exist to be there for people in the best and hardest moments of their lives.

Our team is the power behind that promise. And, as the industry rapidly evolves and we seek ways to optimize business processes and customer experiences, there's no greater time for forward-thinking professionals like you to join us in delivering on it!

As a member of Team Blue, you'll find purpose, opportunities and the support you need to build a meaningful career and make a powerful impact in our community.

BCBSNE is happy to offer four work designations for our Omaha area employees: 100% in-office, Hybrid options, and 100% remote. If choosing to work remote, this role can be located in one of the following states: Colorado, Florida, Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, and Texas.

This role is responsible for identifying and implementing all coding edits for the Company's claims processing system. This role will educate internal and external customers on appropriate billing and coding practices and policies. It will also analyze data related to billing and coding for reimbursement related polices.

What you'll do:

• Provide information/documentation and support to implement coding edits for use in the Company's claims processing system.
• Review, edit, and maintain all current reimbursement policies, and develop any new reimbursement policies for the Company.
• Research and analyze claim data for inappropriate billing practices, inappropriate coding, and any other reimbursement methodology concerns. This will include investigation of APR-DRG's, CPT/HCPCS codes, Revenue Codes, ICD-10's, any potential Company auditor errors, any potential system errors, inappropriate application of benefits, or any other factors deemed necessary to appropriately adjudication claims.
• Identify and provide background information and analysis during annual reimbursement change/update process.
• Work collaboratively with Business Analytics, Provider Relations Managers, Special Investigations Unit, and other inter-department teams on a wide variety of reimbursement related projects.
• Keep abreast of changes to internal medical policy, benefit changes, reimbursement updates and coding/billing guidelines to be able to incorporate the most current information when working with providers and internal staff.
• Using oral and written communications skills to obtain and/or present information to internal staff and providers. Work with Medical Support and Medical Management on provider inquiries that relate to current or potential medical policies.

To be considered for this position, you must have:

• Associate's Degree from an accredited college or university in healthcare, medical coding, accounting, finance, or a related field and/or three (3) years' experience in healthcare is required.
• Current AAPC CPC (Certified Professional Coder) or AHIMA CCS (Certified Coding Specialist) credential is required.
• Understanding of institutional, professional and ambulatory surgery reimbursement methodologies including CPT/HCPCS, RBRVS, APR-DRG's, and EAPG's.
• Intermediate to advanced Microsoft Office skills.
• Previous Medical Coding experience required.

An equivalent combination of education and experience may be substituted for this requirement.
The ability to meet or exceed the attendance and timeliness requirements of their departments.
The ability to work well in a team environment, and be capable of building and maintaining positive relationships with other staff, departments, and customers.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and or ability required.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Other duties may be assigned.

Learn more about what makes BCBSNE such an exceptional place to work by visiting NebraskaBlue.com/Careers.

We strongly believe that diversity of experience, perspective and background will lead to a better workplace for our employees and a better product for our customers and members.

Blue Cross and Blue Shield of Nebraska is an Equal Opportunity /Affirmative Action Employer - Minorities/Females/Disabled/Veterans