Medical Information Specialist - ADV00006- ORC

<strong>With more than 7,000 employees, we are the largest health insurance company in Michigan. We offer an exciting work environment with a diverse group of employees. Our goal is to make health insurance easier for our members. We want to transform the industry and become a resource that people can trust.</strong>

Southfield, MI

Blue Cross Blue Shield of Michigan

When you think of <a href="https://www.bcbsm.com/" target="_blank" rel="noopener noreferrer">Blue Cross Blue Shield of Michigan</a> for health insurance, you can know you&rsquo;re getting much more. We're a company founded on a tradition of affordable, quality health care for everyone, improving the present and investing in the future.&nbsp;<br /><br />We offer:<br />Plans for employers and individuals that meet today&rsquo;s needs, budgets and lifestyle<br />The largest network of doctors and hospitals in the state<br />Lower health care costs Higher quality health care<br />Award-winning diversity practices<br />Grants and programs that promote better health throughout Michigan<br /><strong><br />Mission:&nbsp;</strong>We commit to being our members&rsquo; trusted partner by providing affordable, innovative products that improve their care and health.<br /><br /><a href="http://www.bcbsm.com/index/about-us/our-company.html" target="_blank" rel="noopener noreferrer"><strong>Click here</strong></a> to learn more about our commitment to our Social Mission, view company updates and reviews, and view our awards &amp; accolades.<br /><br />For Application Timeline &amp; Selection Process:&nbsp;<a href="https://s3.amazonaws.com/data.vizirecruiter.com/Images/BCBSMCareers+-+Quick+Reference+Guide.pdf" target="_blank" rel="noopener noreferrer">Click Here</a>. Learn more about your options as an external candidate. <a href="https://ejko.fa.us2.oraclecloud.com/hcmUI/CandidateExperience/en/sites/CX_3/requisitions" target="_blank" title="BCBSM" rel="noopener noreferrer">Click here</a> to view open positions. http://www.bcbsm.com

keywords: job description,communication,services,operations,education,experience,skills

Full-time

Competitive Total Compensation Package

Overview: <br />Provide thorough analysis and investigation of authorization requests for specialized medical/surgical/outpatient procedures in an expeditious and accurate manner ensuring provider, hospital/facility, Primary Care Group (PCG), and member quality customer service. Provide information and assistance pertaining to the Medical Management program to providers, hospitals, PCGs, and members.<br /><br /> <p><strong>Department Info:</strong></p> <p>Since the work covers business across several time zones, the shifts will be flexible. Shifts will include 9-5:30pm, 10:30-7pm, and 12:30-9pm (total of 40 hours per week).</p>
Responsibilities: <br /> <ul> <li>Assess and investigate requests for medical service authorization and authorize select services that do not require clinical judgment. Collect and record appropriate data in order to issue authorization and route requests for services that require medical review to the appropriate team member(s).</li> <li>Facilitate communication with providers regarding status on authorizations and referrals. Identify relevant issues and route to appropriate department for action and resolution.</li> <li>Perform departmental functions such as data preparation/presentation, interaction with internal and external sources to resolve inquires, assist with on-the-job training of new employees as requested, educate and direct providers on medical management policy, procedures, plan benefits and co-pays for all products.</li> <li>Promote and engage in positive and constructive daily team interactions.</li> <li>Perform other duties as assigned.</li> </ul>
Requirements: <br /> <ul> <li>Associate&rsquo;s Degree in Health Care Administration or other health-related field, or two (2) years full-time college credits preferred.</li> <li>Current Michigan licensed LPN, RHIT (Registered Health Information Technician) or Certified Medical Assistant designation preferred.</li> <li>Validated successful completion of medical terminology course required. Completion of a medical terminology course at an accredited college or career school is preferred.</li> <li>College-level course work in anatomy and physiology preferred.</li> <li>One (1) year experience in a clinical or health insurance setting and one (1) year experience in customer service required.&nbsp; Customer and telephonic servicing techniques required.</li> <li>One (1) year experience with ICD10, HCPCS, and CPT coding preferred.</li> <li>Knowledge of managed care philosophy, policies, and procedures preferred.</li> <li>Knowledge of BCN/BCBSM policies, procedures, and benefits preferred.</li> <li>Demonstrated good verbal and written communication.</li> <li>Time management, analytical, and problem-solving skills in order to service providers, facilities, members, and internal departments. Must be able to multi-task; organized self-starter with the ability to prioritize.</li> <li>Knowledge of current standard personal computer operations required.</li> </ul>