Blue Cross & Blue Shield of Mississippi · 4 months ago
Provider Compliance Specialist
Flowood, MS
Full-time
Onsite
Entry Level
2+ years expBlue Cross & Blue Shield of Mississippi is committed to fostering professional growth in a dynamic environment. The Provider Compliance Specialist is responsible for supporting fraud, waste, and abuse detection and prevention activities, including claims review and hotline monitoring.
Health InsuranceInsuranceNon Profit
Responsibilities
Supporting Provider Compliance’s fraud, waste and abuse detection and prevention activity through reviewing claims pended for fraud, waste and abuse review
Conducting fraud, waste and abuse research and claims reviews on focus areas or aberrances
Preparing reporting on department fraud, waste and abuse related activity
Monitoring the Company’s Fraud, Waste and Abuse hotlines
Conducting research to resolve issues reported via the hotlines
Preparing reporting on Hotline activity
Qualification
Required
A Bachelor's Degree in a course of study which complements this position is required
Minimum GPA of 3.0 (on a 4.0 scale or equivalent measure)
Minimum of two (2) years professional experience required; compliance, audit or healthcare related experience preferred
PC skills required to include the Microsoft Office Suite
Effective oral and written communications skills
Preferred
Minimum of two (2) years professional experience required; compliance, audit or healthcare related experience preferred
Knowledge of Blue Cross & Blue Shield of Mississippi claims processing procedures and systems, including CAS, strongly preferred
Benefits
Comprehensive benefits package that is worth approximately one-third of the salary compensation
Benefits program is among the best in the health care field
Company
Blue Cross & Blue Shield of Mississippi
Blue Cross & Blue Shield of Mississippi is a mutual insurance company that provides health insurance services.
1001-5000 employees
Funding
Current Stage
Late StageLeadership Team
Lindsey Tong Sisneros
Executive Assistant to the Chief Financial Officer
Marc A. Dunn
Director of Provider Partnerships
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