Medical Policy & Special Project Clinical Analyst (RN Required)

At Blue Cross and Blue Shield of Nebraska, we are a mission-driven organization dedicated to championing the health and well-being of our members and the communities we serve.

Our team is the power behind that promise. And, as the industry rapidly evolves and we seek ways to optimize business processes and customer experiences, there’s no greater time for forward-thinking professionals like you to join us in delivering on it! As a member of Team Blue, you’ll find purpose, opportunities and the support you need to build a meaningful career and make a powerful impact in our community.

This position is responsible for assisting in the maintenance of medical policy related to coding changes and analysis, providing ongoing technical support and configuration in the claims system. In addition to maintenance of Medical Policy, this position will assist the Health Policy Research lead with Medical Policy research and development. This position is responsible for assisting the policy lead with day to day responsibilities for special projects related to medical claims processing, including special project assignments. Additional responsibilities include identifying and implementing coding edits in the HealthRules claims processing system (and any other relevant BCBS NE systems), in collaboration with the internal HealthRules configuration teams and sharing of best practices for claims processing. This individual will lead coordination and ensure completion of quality assurance and user testing of coding change configurations that reflect policy changes with the UAT team and other related BCBS NE teams.

Candidates applying to this position may be hybrid or remote and can live in one of the following states: Florida, Iowa, Kansas, Missouri, Nebraska, North Dakota, and Texas.

What you'll do:

• Medical Policy maintenance of coding changes, analysis, policy and technology support
• Assistance with special projects
• Provide information, documentation and support to implement HealthRules configuration
• Collaborate with and assist business partners to perform user acceptance and end-to-end claims testing
• Identify system problems and open tickets in HE to resolve issues as needed, in collaboration with HE IT staff
• Responsible for fostering a constructive relationship with team members in HealthEdge and other departments within BCBSNE

To be considered for this position, you must have:

• Degree in nursing and three (3) years clinical practice experience in a healthcare setting and three (3) years experience with medical coding, including working with ICD -10 codes, CPT, HCPCS and Correct Coding Initiative (CCI) edits.

• Experience with claims and benefit technology functions, information handling, and work flow processing.

• Experience with Microsoft Business Applications, including Excel and Word.

The strongest candidates for this position will also possess:

• Certified Professional Coder (CPC) Certification.
• Experience within the Health Insurance Industry.

Learn more about what makes BCBSNE such an exceptional place to work by visiting NebraskaBlue.com/Careers.

We strongly believe that diversity of experience, perspective and background will lead to a better workplace for our employees and a better product for our customers and members.