Full-Time

Registered Nurse Coder

DRG Reviewer

Posted on 11/21/2024

Blue Cross Blue Shield

Blue Cross Blue Shield

1,001-5,000 employees

Healthcare

Junior, Mid

Remote in USA

Remote opportunity within and outside the State of Arizona.

Category
Nursing & Allied Health Professionals
Medical, Clinical & Veterinary

You match the following Blue Cross Blue Shield's candidate preferences

Employers are more likely to interview you if you match these preferences:

Degree
Experience
Requirements
  • Experience in clinical and health insurance or other healthcare related field
  • Managed care experience with a focus on Utilization Management (UM), Prior Authorization (PA), Claims, Medical Review, Case Management, and/or Medical Appeals and Grievances (MAG)
  • Associate’s Degree in a healthcare field of study or Nursing Diploma
  • Active, current, and unrestricted license to practice in the State of Arizona as a Registered Nurse (RN)
  • Certified Medical Coder
Responsibilities
  • Perform in-depth analysis, clinical review and resolution of provider pre and post payment claims
  • Review and prepare internal audit cases for Medical Directors
  • Identify, research, process, resolve and respond to Sr. Medical Director inquiries
  • Analyze medical records and apply medical necessity criteria and benefit plan requirements
  • Maintain complete and accurate records per BCBSAZ policy
  • Consult and coordinate with various internal departments, external plans, providers, businesses, and government agencies
  • Participate in continuing education and current developments in the fields of medicine and managed care
  • Demonstrate ability to acquire specialized knowledge to complete all types of projects for all lines of business
  • Adheres to BCBSAZ brand promise of being a 'Trusted Advisor'
Desired Qualifications
  • Experience in clinical and health insurance or other healthcare related field
  • Managed care experience with a focus on Utilization Management (UM), Prior Authorization (PA), Claims, Medical Review, Case Management, and/or Medical Appeals and Grievances (MAG)
  • Bachelor's Degree in Nursing or related field of study
  • Masters Degree in Nursing or related field of study
  • Active, current, and unrestricted license to practice in the State of Arizona as a Registered Nurse (RN)
  • Certified Medical Coder
Blue Cross Blue Shield

Blue Cross Blue Shield

View

Company Stage

N/A

Total Funding

N/A

Headquarters

Chicago, Illinois

Founded

1910

Simplify Jobs

Simplify's Take

What believers are saying

  • Telehealth expansion can meet growing consumer demand post-COVID-19 pandemic.
  • Value-based care models can improve patient satisfaction and reduce operational costs.
  • Increasing demand for mental health services offers growth opportunities for BCBS.

What critics are saying

  • Rising healthcare claims costs could strain BCBS's financial resources.
  • Antitrust lawsuits may lead to significant financial penalties and regulatory scrutiny.
  • COVID-19 vaccine mandate issues could affect workforce stability and public perception.

What makes Blue Cross Blue Shield unique

  • Blue Cross Blue Shield offers Blue Distinction Centers for specialized medical procedures.
  • The company collaborates with cities for community health initiatives like Bluebike unlocks.
  • BCBS promotes data-driven healthcare with leadership roles like VP of Enterprise Data.

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Benefits

Health Insurance

Hybrid Work Options

INACTIVE