Team Leader II - Clinical Editing

<p><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></p>

Southfield, MI

Blue Cross Blue Shield of Michigan

When you think of <a href="" 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.<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="" 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 />Learn more about your options as an external candidate. <a href="" target="_blank" rel="noopener noreferrer">Click here</a> to view open positions.

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Competitive Total Compensation Package

Overview: <p><strong>Department Summary / Preferences:</strong></p> <div id="textContent" class="readOnlyFrame">Responsible for planning, coordinating and supervising clinical editing team to ensure timely and accurate processing of appeals and inquiries in accordance with corporate and departmental policies. Will also be responsible for processing of clinical editing appeals and inquiries, coordinating team and inter-rater meetings, as well as managing work assignments.</div> <ul> <li class="readOnlyFrame">ICD-10 and CPT/HCPCS coding courses required;</li> <li class="readOnlyFrame">Minimum of 4 years experience billing and coding required, preferably in claims resolution, along with medical record review</li> <li class="readOnlyFrame">Coding certification required (eg, CPC certification). Will consider those with certification in process, with certification to be obtained within 6 months of hire.</li> <li class="readOnlyFrame">Working knowledge of medical coding standards, including HCPCS, CPT and ICD-10, etc. required.</li> <li class="readOnlyFrame">Working knowledge of BCBSM and BCN reimbursement and claims processing guidelines preferred.</li> <li class="readOnlyFrame">Knowledge of CCI and Medicare reimbursement guidelines preferred.</li> </ul> <p><strong>Responsible for planning, coordinating and supervising assigned departments(s)/area(s) to ensure an efficient and cost effective area of responsibility in accordance with established corporate and departmental policies and procedures.</strong></p>
Responsibilities: <ul> <li>Supervise and promote the professional development of assigned staff through selection, development, and exploration of more effective methods of managing projects and time.</li> <li>Research, (internally and externally), initiate, and plan strategic changes in assigned department(s)/area(s) to optimize technologies and personnel.</li> <li>Recommend and assist in acquisition of technology and other tools or equipment and resources to optimize departmental performance and output.</li> <li>Prioritize and assign work to employees and initiate corrective measures to resolve problems, including scheduling or adjusting overtime requirements as necessary.</li> <li>Interface with diverse levels of internal and external personnel to develop and maintain effective rapport and to resolve issues and inquiries.</li> <li>Administer and adhere to Corporate and departmental policies, practices and procedures.</li> </ul>
Requirements: <div id="requisitionDescriptionInterface.ID1582.row1" class="inlinepanel" title=""><span class="subtitle">Qualifications</span></div> <ul> <li>Bachelor's Degree in related field preferred.</li> <li>A minimum of 90 college credits is required.</li> <li>Five (5) years of BCBSM/BCN and/or related field experience including at least two (2) years of experience</li> <li>in a leadership role.</li> <li>Strong organizational, planning, analytical and communication skills.</li> <li>Excellent interpersonal skills necessary to interact with all levels of personnel.</li> <li>Working knowledge of PC application and/or mainframe systems preferred.</li> <li>Other related skills and/or abilities may be required to perform this job.</li> </ul>