BlueCross BlueShield of Tennessee · 16 hours ago
LTSS Provider & FEA Liaison
United States
Full-time
Remote
Mid Level
3+ years expBlueCross BlueShield of Tennessee is seeking an LTSS Claims Liaison to empower providers and support workforce development. This role involves educating providers on claims submission, resolving inquiries, and developing training strategies to enhance compliance and quality care for TennCare members.
Health CareMedical
Responsibilities
Provide for education and technical assistance regarding appropriate claims submission processes and requirements including, coding updates, electronic claims transactions and electronic funds transfers. Research and resolve claims issues and inquiries promptly
Develop strategies to improve the effectiveness of BlueCare claims education and technical assistance activities
Develop and maintain BlueCare provider resources i.e. provider manual, fee schedules, website, training materials
Provide education and assistance with consumer-directed workers to resolve problems and address inquires
May support initial and ongoing workforce development strategies and goals to support measurable actions to help ensure a qualified, competent, and sufficient workforce to consistently deliver needed services in a timely manner
Develop and initiate claims training and intervention to help provider obtain and retain compliance
Support ongoing quality initiatives for LTSS providers, and other TennCare amendment changes
Qualification
Required
Bachelors degree in business or healthcare or relevant field or equivalent work experience required
3 years - Experience managing health plan accounts with multiple customer lines
Working knowledge of healthcare claims, customer service, provider network contracting, and contract compliance
Ability to conduct root cause analysis, plan, organize and coordinate multiple projects
Ability to quickly take complex technical subjects and distill them into user-friendly presentations and digital communications
Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles and accountability
Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint)
Excellent oral and written communication skills
Strong interpersonal and organizational skills
Proven decision making and problem solving skills
Knowledge and understanding of TennCare contracts as well as state and federal regulatory requirements
Proficient in Facets and CareAdvance
Preference for candidates who have experience with medical claims & knowledge of LTSS programs in Tennessee
Candidates must live in Tennessee or a contiguous county
Preferred
LTSS experience is highly preferred
Strong claims experience and understanding is preferred
Company
BlueCross BlueShield of Tennessee
As Tennessee's largest health plan, we've been helping Tennesseans find their own unique paths to good health for more than 70 years.
5001-10000 employees
Funding
Current Stage
Late StageLeadership Team
Casey Dungan
President and Chief Executive Officer - BlueCare
Melissa Scissom
COO, Cover Tenn
Recent News
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