Medical Review Claims - Nurse Coordinator

Job description

Are you ready to make a difference? Choose to work for one of the most trusted companies in Kansas. Why Join Us? Make a Positive Impact: Your work will directly contribute to the health and well-being of Kansans. Family Comes First: Total rewards package that promotes the idea of family first for all employees. Paid vacation and sick leave with paid maternity and paternity available immediately upon hire Professional Growth Opportunities: Advance your career with ongoing training and development programs. Dynamic Work Environment: Collaborate with a team of passionate and driven individuals in a work environment that promotes flexibility. Trust and Stability: Work for one of the most trusted companies in Kansas with over 80 years of commitment, compassion and community. Inclusive Work Environment: We pride ourselves on fostering a workplace where everyone is valued and respected. Benefits & Perks Base compensation is only one component of your competitive Total Rewards package Incentive pay program (EPIP) Health/Vision/Dental insurance 6 weeks paid parental leave for new mothers and fathers Fertility/Adoption assistance 2 weeks paid caregiver leave 401(k) plan matching up to 5% Tuition reimbursement Health & fitness benefits, discounts and resources Job Summary The Medical Review Claims Nurse Coordinator directly oversees the day-to-day activities of a team of medical review nurse consultants. Co-responsible, with the other Coordinator and Analyst Supervisor, to research, develop, and implement all training / education materials for the entire Medical Review department. Responsible for ensuring employee production and quality meets department / company goals. Responsible for receiving, researching, answering all direct questions from employees and other departments / divisions regarding employee reviews / decisions. Lead multiple departmental meetings and projects. Participate in divisional meetings along with the Manager. Work Location This position is eligible to work remotely, hybrid or onsite in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment. What you'll do Accountable for performance monitoring, policy enforcement, termination process, disciplinary action, hiring, compliance and team development. Maintaining accurate records of all hiring, firing and disciplinary actions. Ensure supervised employees are compliant with all company, state, and federal regulations. Lead / participate in multiple cross division/department teams. Ensure all supervised employees maintain their clinical licensing and professional coder certifications. Co-responsible for researching, creating, implementing, and maintaining all department processes and education / training material with regular team training sessions. Accountable for identifying and researching production inconsistencies involving policy questions and other problem areas and present solutions to management. Subject matter expert for department, division, and senior management inquiries. Conduct regular audits and assessments of the claim review process to ensure accuracy, regulatory compliance, and identify areas for process improvement. Provide ongoing support and mentorship to staff, fostering professional development and growth. Accountable for independent approval of claims up to $1 million. Must follow URAC standards as required for essential job functions. Education Bachelor's degree or equivalent in nursing or health related field required Experience Minimum 6 years' experience in a clinical nursing role (Medical Review Claims experience counts) required Minimum 3 years' experience Medical Review Claims experience preferred Minimum 1 years' experience in a supervisor or leadership role preferred Licenses and Certifications Current, active, unrestricted Kansas RN License required Certified Coder-AHIMA or AAPC within 3 years of hire required Travel No travel Knowledge, Skills and Abilities Must be able to effectively supervise a team with diverse personalities, educational backgrounds, and various management and non-management levels with a wide range of technical / medical understanding. Must be self-directed with the ability to make independent decisions and prioritize personal and employee production activities. Must be able to review and manage sensitive situations related to employees and BCBSKS customers in a positive professional manner. Maintain a working knowledge of medical trends that may affect department production. Must have strong computer skills to operate effectively with company systems and programs. Must be able to maintain a productive and professional relationship with multiple cross departmental and divisional teams. Must be able to communicate technical / medical subjects to employees with sufficient clarity to explain decision outcomes and justify recommendations to team members, senior management, other departments / divisions. Must have a strong analytical background. Compensation $85,600 - $107,000 annually Exempt Grade 16 Blue Cross and Blue Shield of Kansas offers excellent competitive compensation with the goal of retaining and growing talented team members. The compensation range for this role is a good faith estimate, it is estimated based on what a successful candidate might be paid. All offers presented to candidates are carefully reviewed to ensure fair, equitable pay by offering competitive wages that align with the individual's skills, education, experience, and training. The range may vary above or below the stated amounts. Our Commitment to Connection and Belonging At Blue Cross and Blue Shield of Kansas, we are committed to fostering a culture of connection and belonging, where mutual respect is at the foundation of our workplace. We provide equal employment opportunities to all individuals, regardless of race, color, religion, belief, sex, pregnancy (including childbirth, lactation, and related medical conditions), national origin, age, physical or mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information (including characteristics and testing), military or veteran status, family or parental status, or any other characteristic protected by applicable law. Blue Cross and Blue Shield of Kansas conducts pre-employment drug screening, criminal conviction check, employment verifications and education as part of a conditional offer of employment.