Analyst - Clinical Editing

<p>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.</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.

keywords: professional,support,process management,compliance,research,experience,department preferences,degree,skills,knowledge


Competitive Total Compensation Package

Overview: <strong><span style="font-size: small;">Provide functional technical and analytical support to assigned BCN department (e.g. Claims, Medical Policy, Enrollment, Membership and Billing, etc.).&nbsp; This may include problem identification and resolution, documentation, analysis, recommendation, and implementation of new or enhanced work processes, systems, and reports.&nbsp;</span></strong>
Responsibilities: <ul> <li>Provide support to assigned departmental leadership through technical, analytical and subject matter knowledge.</li> <li>Research problems reported by other staff; evaluate possible corrective actions, recommend and implement solutions.</li> <li>Investigate and respond to inquiries from other internal departments and external entities.</li> <li>Develop and implement changes to processes and procedures to correct and improve business unit performance.</li> <li>Assist in documenting departmental procedures.</li> <li>Test and document new and modified system changes.</li> <li>Update departmental processes, monitor error and compliance reports to support departmental performance and to ensure adherence to goals, internal and external customer expectations, and requirements from external entities such as CMS, BCBSA and other regulatory agencies.&nbsp;&nbsp; Participate on special projects or work group as assigned.</li> </ul>
Requirements: <p>Department Preferences:</p> <ul> <li>Coding certification</li> <li>4 years&rsquo; experience</li> <li>Experience with coding and review of medical records</li> <li>Multi-specialty experience</li> </ul> <p><strong>EDUCATION AND OR EXPERIENCE</strong></p> <ul> <li>Associate's Degree in business or health care related field.</li> <li>Three (3) years related experience in managed care operations including specific functional experience related to assigned department.</li> </ul> <p><strong>OTHER SKILLS AND ABILITIES</strong></p> <ul> <li>Excellent verbal, written communication and interpersonal skills ability to work in a team environment.</li> <li>Excellent analytical and problem-solving skills to identify, evaluate, recommend and implement changes to processes or procedures in order to address problems and improve departmental effectiveness.</li> <li>Organizational skills and ability to prioritize must be able to coordinate multiple activities with varying timelines.</li> <li>Demonstrated knowledge of Microsoft Office suite and software, database applications.</li> <li>Other related skills and/or abilities may be required to perform this job.</li> </ul>