Blue Cross & Blue Shield of Mississippi ยท 1 day ago
Provider Appeals Specialist
Flowood, MS
Full-time
Onsite
Entry Level
1+ years expBlue Cross & Blue Shield of Mississippi is dedicated to promoting health and wellness in a professional environment. The Provider Appeals Specialist is responsible for reviewing and making decisions on provider appeals, applying coding expertise, and composing educational responses to prevent repeat appeals while identifying quality improvements for efficient business processes.
Health InsuranceInsuranceNon Profit
Responsibilities
Review, research, and make decisions on provider appeals to include Benefit, biometric, Physician allowance, Color Me Healthy and Coding appeals using the Plan documents and other resources, in a clear, concise and timely manner
Accountable to apply coding expertise in handling coding appeals
Compose provider responses that are educational in nature to prevent repeat appeals where possible
Identify quality improvement to ensure efficient business processes and accurate claims processing where deficiencies are noted in CAS page instructions, system edits, etc
Qualification
Required
Bachelor's degree required
Twelve months of BCBSMS service or have at least one year of physician based coding experience
Excellent written communication skills required
Strong analytical skills to investigate complex information
Must have strong PC skills and knowledge of computer applications to include Microsoft Word and Excel
Preferred
Multi-specialty coding experience is preferred
Experience utilizing CAS preferred
Knowledge of Internal and External appeal regulations preferred
Knowledge of claims filing, office administration, or related organizational skills preferred
Benefits
Comprehensive benefits package
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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