CASY-MSCCN Jobs

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 the identification, analysis and development of post-pay recovery rules that ensure claims are paid per policy. A Day in the Life: Conducts in-depth research and analysis. Maintains monthly queries to tag and identify potential recoveries Validate and review vendor data-mining findings for accuracy Review reimbursement policy for potential enhancements or additions to current workstreams Creates and develops post-pay rules and works with collaboration partners to implement into current process Effectively analyzes, designs, develops, tests, debugs, implements, maintains and/or enhances new or existing systems through reporting and documentation. Participate in and coordinate individual projects and related activities to ensure project progresses on schedule. Maintains adequate communication regarding project status, risks, issues, and priorities with project sponsors and leadership. Acts as a liaison with internal partners and external partners to identify opportunities and needs and researches/develops implementation plans for meeting these needs. Serves as senior subject matter expert associated with content, processes, and procedures. Required Skills and Experiences: 5+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered. Advanced collaborative, interpersonal, oral and written communication skills and demonstrated ability to develop accurate and appropriate communications. Advanced ability to communicate to all levels of management. Advanced research, analytical and problem solving skills. Advanced skills in Microsoft Excel, Word, and Access. Strong ability to make decisions based on analysis and business needs. Advanced ability to bring a different perspective to situations and challenge the status quo. Project management skills. Proven ability to work independently with guidance in only the most complex situations. Nice to Have: Bachelor's degree. Expertise of coding rules and requirements. Knowledge of pharmacy coding and pharmacy pricing. 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.