A Career of Your Calling

About Blue Cross and Blue Shield of Minnesota

At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing. If you are ready to make a difference, join us.

The Impact You Will Have

This position is responsible for ensuring that reimbursement policies are implemented and integrated with all systems to ensure accurate claims processing. This will include reviewing and applying new codes to the reimbursement policies, developing quality improvement processes for policy implementation, and assisting with data reporting needs, as they pertain to the reimbursement policy decision making process. Additionally, this role will organize communication of reimbursement policy changes and issues. This position will also serve as a support resource within the division and within the reimbursement policy team.

Your Responsibilities

• Implement and measure policies and integrate with all systems to ensure accurate claims processing.
• Assure that changes in policies are communicated to all lines of business.
• Research and apply appropriate and regular updates of CPT, HCPCS, and ICD-9/ICD-10 coding to the policies.
• Prepare final policy documents and tools for implementation.
• Present and provide implementation input to policy committees and meetings.
• Maintain and document system edits, process workflows and process documentation.
• Maintain Blue Cross external and internal policy databases with current policy decisions and coding.
• Produce standard reports and assist in the analysis and impact of these reports as they relate to reimbursement policy implementation process.
• Serve as a subject matter expert to team members and workgroups.
• Support the reimbursement policy team to solution for reimbursement policy issues and overall policy strategy as needed.

Required Skills and Experiences

• 6+ years of related professional experience. All relevant experience including work, education, transferable skills, and military experience will be considered.
• Ability to apply critical thinking skills to policy interpretation and implementation.
• Ability to work independently; well-organized and able to set priorities with minimal direction.
• Ability to effectively communicate both verbally and in writing.
• Strong PC skills, including Excel, PowerPoint, Visio, Word, and internet-based programs.
• Ability to develop and work on several projects at one time in a fast-paced environment.
• Ability to build and maintain relationships with internal and external stakeholders, clinicians, and others.
• Project management experience.
• Demonstrated positive professionalism in all work-related behaviors as demonstrated by adaptability, contributing to team success, customer focus, skillful communication, and efficiently managing work.
• Strong documentation and workflow process skills.
• Experience with measuring and monitoring plans.
• High school diploma (or equivalency) and legal authorization to work in the U.S.

Preferred Skills and Experiences

• Bachelor’s and/or master’s degree in a clinical or health-related field with 6 years’ experience working in a health care environment.
• End to end claims process experience.

Compensation and Benefits:

Pay Range: $77,200.00 - $102,300.00 - $127,400.00 Annual

Pay is based on several factors which vary based on position, including skills, ability, and knowledge the selected individual is bringing to the specific job.

We offer a comprehensive benefits package which may include:

• Medical, dental, and vision insurance
• Life insurance
• 401k
• Paid Time Off (PTO)
• Volunteer Paid Time Off (VPTO)
• And more

To discover more about what we have to offer, please review our benefits page.

Equal Employment Opportunity Statement

At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. Blue Cross of Minnesota is an Equal Opportunity Employer and maintains an Affirmative Action plan, as required by Minnesota law applicable to state contractors. All qualified applications will receive consideration for employment without regard to, and will not be discriminated against based on any legally protected characteristic.

Individuals with a disability who need a reasonable accommodation in order to apply, please contact us at: talent.acquisition@bluecrossmn.com.

Blue Cross® and Blue Shield® of Minnesota and Blue Plus® are nonprofit independent licensees of the Blue Cross and Blue Shield Association.