Certified Medical Claims Analyst

Job Summary

To support accurate claims processing, the full-time Medical Review Claims Analyst will conduct non-clinical reviews of claims and inquiries, ensuring compliance with guidelines while working remotely or onsite in Kansas or Missouri.

Key responsibilities

• Conduct independent non-clinical reviews of claims and inquiries using relevant contracts and medical policies
• Ensure timely and accurate processing of claims in accordance with corporate and federal guidelines
• Identify aberrant provider activity and provide support for internal inquiries related to coding and claims processing

Required qualifications

• High school diploma or equivalent required
• Minimum 3 years' experience in BCBSKS Claims or Customer Service, or 2 years' experience in medical coding with AAPC certification, or 3 years' experience in medical coding required
• Certified Coder-AHIMA or AAPC certification required within three years of hire
• Strong analytical skills and knowledge of medical terminology, coding systems (ICD-10, CPT, HCPCS)
• Ability to maintain productive relationships across departmental teams