Capital BlueCross is the
leading health solutions and insurance company in Central Pennsylvania and the
Lehigh Valley. As a partner in the community’s health for 80 years, we offer
health insurance products, services, and innovative technology solutions that
provide peace of mind to consumers and promote health and wellness for our
customers.
More than a health
insurer, the company delivers innovative solutions through a family of
diversified businesses that is creating a healthier future and lowering health
care costs. Among these solutions are patient-focused care models, leading-edge
data analytics, and digital health technologies.
Capital BlueCross has an
exciting opportunity for a Medical Policy &
Coding Consultant to join our award winning organization. Proud
to be named a Best Places to work in PA, Harrisburg Magazine’s Simply the Best,
Highest Member Satisfaction J.D. Power Award, and since 2014, Capital BlueCross
has scored higher than all health insurance providers publicly measured in the
American Customer Satisfaction Index (ACSI). Please click the following
link to see additional awards and information regarding our company http://capbluecross.mediaroom.com/.
Each member of our
organization--now spanning five generations, knows that there is a person-- a
neighbor, a friend, a family member--relying on us to ensure an effortless
experience as we deliver on our promises. Capital BlueCross offers
employees excellent pay, bonus opportunities, benefits, health and wellness
incentives, opportunities for career advancement and community involvement, and
work-life balance. In return, every member of our workforce plays an
important part in something much bigger: working together and making a
difference every day to improve the health and well-being of our members and
the communities in which they live. If you are looking to make a difference
every day in the community for which we live and have the skills and
qualifications listed below, we invite you to take the first step in making
that difference.
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Summary:
This position is
responsible for serving on the Medical Policy and Coding team to maintain
medical policy and corporate coding structures. This typically involves:
·
Conducting medical
policy research to create, revise, or archive assigned medical
policy
·
Reviewing Federal/State
mandates to ensure assigned medical policy is compliant with regulatory
requirements
·
Writing medical policy
as assigned and applying procedure and diagnosis codes
·
Supporting vendor
programs, new code, single source, and special projects and coding initiatives
·
Monitoring for
trends/patterns/changes in medical care
·
Completing comparisons
of local/competitor plans
·
Generating and analyzing
claim reports to provide impact assessments, mitigate stakeholder concerns, and
and ensure payment is correct
·
Participating in
Clinical Advisory Committee meetings, Pre-Configuration meetings, Utilization
Management meetings, etc.
JOB REQUIREMENTS include Current and non-restricted clinical
licensure within the Commonwealth of PA, and 3-5 years of clinical
experience, as well as at least 3-5 years of experience with medical
policy, coding, and diagnosis coding (ICD10, CPT, CDT, HCPCs, revenue
codes, etc.). Also required is a solid working knowledge of
government regulatory and accrediting and related policies and regulations
(PPACA, CMS, FEP, NCQA, URAC, DOH, Medical Assistance, etc.),
and demonstrated proficiency in the use of Microsoft Office Suite (Outlook
Word, Excel, Power Point, Access, Share Point).
Medical Coding
certification (CPC and/or COC) is preferred, and required within one (1) year
of hire. This position also requires exceptional organizational skills,
attention to detail, and ability to work effectively with minimal supervision.
Additionally, the ability to perform basic arithmetic, percentage and
statistical calculations is essential.
************************************************************************************************************************Our
innovative Capital Blue Health and Wellness Centers located in Enola and Center
Valley provide in-person service and inspiration to help people reach their
health goals. Each one is open to the public and includes a fitness studio,
Healthy You Café and on-site care guides skilled in multiple areas, including
nutrition and biometrics screening. Capital BlueCross employees can take
advantage of the many services offered at Capital Blue at little to no cost.
Capital BlueCross is an
independent licensee of the BlueCross BlueShield Association. We are an equal
opportunity/affirmative action employer and do not discriminate on the basis of
race, color, religion, national origin, gender, sexual orientation, gender
identity, age, genetic information, physical or mental disability, veteran
status, or marital status, or any other status protected by applicable law.
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