Medicare Reimbursement Analyst

Summary:
This position is responsible for acting as the liaison between Blue Cross
Blue Shield of Minnesota and the state and/or federal governments when
revenue discrepancies are identified. The Reimbursement Analyst works
in conjunction with the Reimbursement Specialists within the department
as well as external stakeholders to research and resolve payment
discrepancies.

Accountabilities:

1.Take ownership of assigned special statuses (i.e. Institutional, Hospice,
End Stage Renal Disease, etc) and become a Subject Matter Expert for the
team
2.Analyze and reconcile reports related to assigned statuses
3.Assist in tracking member discrepancies from identification through
resolution.
4.Assist in performing monthly institutional verification via phone calls to
providers.
5.Collaborate with the Membership department to reconcile conflicting CMS
and NMBS data.
6.Assist in administering the Working Aged survey including tracking and
follow-up calls to members.
7.Communicate regularly with CMS/DHS to resolve issues
8.Generate Regional Office correspondence and required documentation to
gain resolution of issues
9.Represent the Reimbursement Management department during CMS/DHS
audits including file preparation activities
10.Identify process improvements and drive the implementation of identified
efficiencies
REQUIREMENTS
Job Requirements:

1.Bachelor's degree and/or *equivalent experience is required. (*a minimum
of 3 years of related medicare/medicaid experience)
2.Knowledge of Medicare and/or Medicaid enrollment processes and their
effect on reimbursement required.
3.Proven ability to work independently
4.Ability to understand complex government regulations and instructions.
5.Excellent written and verbal skills
6.Ability to work in a fast paced environment while demonstrating flexibility in
work assignment and work overtime as needed
7.Experience participating in regulatory audits
8.Detail oriented analytical skills, strong initiative and ability to work in a team
environment.
9.Previous telephone and customer service experience is preferred
10.Previous CMS reconciliation experience is preferred
11.Previous experience working with claims is preferred
12. Intermediate level Microsoft Access preferred
13. Standard work hours 8:00 am - 5:00 pm M-F. Flexible working hours available.

To apply, visit our website at www.bluecrossmn.com