We are seeking an experienced Senior Business Analyst - Medical Coding Configuration to support Medicaid claims processing and payment integrity initiatives. This role focuses on analyzing, configuring, and maintaining medical coding and claims editing rules that drive claim adjudication outcomes, including payment, denial, and pended claim scenarios. The ideal candidate will have deep expertise in healthcare claims processing, medical coding methodologies, and claims editing configuration, with hands-on experience in Optum CES (Claims Editing System) and/or FACETS.
Conducts in-depth research and analysis.
Identifies trends, emerging issues and recommends best practices to ensure maximum results and develops metrics.
Documents metrics and process changes.
Effectively analyzes, designs, develops, tests, debugs, implements, maintains and/or enhances new or existing systems through reporting and documentation.
Participate in and coordinate individual projects and related activities to ensure project progresses on schedule.
Maintains adequate communication regarding project status, risks, issues, and priorities with project sponsors and leadership.
Acts as a liaison with internal partners and external partners to identify opportunities and needs and researches/develops implementation plans for meeting these needs.
Responsible for representing the customer and/or stakeholder (internal/external) while collaborating with business and technical units.
Serves as senior subject matter expert associated with content, processes, and procedures.
May lead project teams and may provide training to lower level staff to achieve project milestones and objectives.
Performs additional responsibilities consistent with the scope and level of the role, as assigned.
5+ years of related information technology professional experience.
Bachelor's degree; in lieu of a degree, an additional two years of relevant experience beyond the qualifications listed above may be accepted.
Hybrid
$90,800.00 - $120,300.00 - $149,800.00 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:
To discover more about what we have to offer, please review our benefits page.
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.
Senior Medical Coding Analyst • Saint Paul, MN, United States
Senior Analyst, Coding Revenue Integrity.Park Nicollet is looking to hire a Senior Analyst, Coding Revenue Integrity to join our team! Come join us as a Partner for Good and help us make an impact ... Show more
Since its launch 6 years ago, over 60MN users have earned and withdrawn over $250MN! The platform is rated 4.TrustPilot with over 230k+ reviews, establishing Freecash as one of the highest-rated op... Show more
Responsible for performing the clerical and administrative functions for any or all hub and station operational areas, including linehaul, quality assurance and customer service.Tends to damaged an... Show more
Product Testers are wanted to work from home nationwide in the US to fulfill upcoming contracts with national and international companies.We guarantee 15-25 hours per week with an hourly pay of bet... Show more
Merchants Bank is seeking a Mortgage Loan Processor.This on-site position can work at any of our branch locations in MN or WI.The primary responsibilities for this position will be performing discl... Show more
Mortgage Loan Officer - Retail.The Mortgage Loan Officer - Retail position provides Simply the Best customer service to each customer at all times.Responsibilities include using internal and extern... Show more
Fairview has an immediate opening for a Medical Assistant to join our Primary Care team at in Chisago City, MN.FTE (68 hours per two week pay period), benefits-eligible opening.Clinic Hours of Oper... Show more
Job DetailsMaintain high level of visibility with associates.Use hands-on approach to communicate daily and involve associates in problem solving.Promote safety and ensure a safe work environment a... Show more
We're looking for a reliable and professional Medical Courier to transport time-sensitive medical materials — including lab specimens, pharmaceuticals, medical equipment, and patient records — betw... Show more
DaVita is looking for a Patient Care Tech to serve our patients at our Wyoming Dialysis Center in Wyoming, MN.Some details about this position:.PCTs usually work 10-12 hour shifts/3-4 days a week (... Show more
DescriptionJob Profile and Summary :The Medical Writer is a member of the Global Medical Affairs and Post Market Surveillance team and is responsible for researching, creating, editing and coordina... Show more
Put your Insurance Experience to work - FROM HOME!At WAHVE, we value significant insurance experience and want to revolutionize the way people think about phasing into retirement by offering qualif... Show more
Responsibilities The primary responsibility of this position is to read meters and record consumption of the water used, cleaning of meter boxes, and removal of vegetation impeding access to meters... Show more
Join Client and help transform leading organizations and communities around the world.The sheer scale of our capabilities and client engagements and the way we collaborate, operate and deliver valu... Show more
Caregiver Opportunity at AccentCare.Find your passion and purpose as a caregiver.Reimagine your career in home care.As a medical professional, you know that what you do impacts you as much as your ... Show more
Billing SpecialistThe Billing Specialist is responsible for ensuring all accounts are processed through insurance properly, and patient accounts are paid in a timely manner.Billing Specialists shou... Show more
Description :Specific Title of the Position :Data Scientist - Databricks / PySparkWork Location :Remote / TelecommuteWork Hours :Estimated 8 hours / day with flexible hours to accommodate remote wo... Show more
Product Testers are wanted to work from home nationwide in the US to fulfill upcoming contracts with national and international companies.We guarantee 15-25 hours per week with an hourly pay of bet... Show more
A healthcare IT firm is seeking a Healthcare Payer Business System Analyst in Eagan, MN.This role focuses on collaborating with teams to analyze healthcare processes and provide data-driven insight... Show more
Job Title :Medical Assistant/Technician (Hospital Corpsman) Category / Component :Enlisted Both Overview Hospital Corpsmen assist healthcare professionals and provide medical and dental care to Sai... Show more
