Blue Cross & Blue Shield of Mississippi · 1 month ago
Senior Clinical Compliance Auditor
Flowood, MS
Full-time
Onsite
Mid, Senior Level
3+ years expBlue Cross & Blue Shield of Mississippi is committed to fostering professional growth and wellness among its employees. The Senior Clinical Compliance Auditor is responsible for reviewing and analyzing clinical data related to billing practices, collaborating with various stakeholders to identify trends, and preparing detailed reports for corrective actions.
Health InsuranceInsuranceNon Profit
Responsibilities
Serve as the primary clinical reviewer of data analysis findings, referrals, appeals and complaints related to Network Hospitals, Providers, Pharmacies, and other entities or programs suspected of inappropriate billing of claims
Select, obtain, coordinate, monitor, and review medical records and other relevant information for clinical and coding assessment and validation of related billing of services provided to Blue Cross Blue Shield Customers
Collaborate with data analysts, compliance auditors, and the Medical Director to identify aberrant trends in patient care, utilization, and billing practices
Work with a multidisciplinary team to determine appropriate interventions to address and resolve identified issues
Prepare clear, detailed findings, reports, and recommendations for corrective action after thorough clinical analysis
Qualification
Required
Bachelor's degree in Nursing
Registered Nurse with an unrestricted license in the state of Mississippi
At least three years of healthcare clinical experience
Knowledge CPT, HCPCS, ICD-10 coding with applicable certifications
Intermediate knowledge of Microsoft Office, to include experience in Excel
Excellent oral and written communication skills with the ability to communicate a clear understanding of results of review finding
Ability to work with a high degree of accuracy and attention to detail
Must have the ability to handle information of a confidential nature
Must possess excellent organizational skills, including the ability to prioritize multiple tasks and perform them both accurately and simultaneously
Must possess strong interpersonal skills with the ability to build strong relationships to encourage trust and open communication
Preferred
Background in Utilization Management or Medical Review
Strong knowledge of health care regulations related to reimbursement and coding
Benefits
Comprehensive benefits package that is worth approximately one-third of the salary compensation
Our 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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