Medical Bill Review & Compliance Advisor

Blue Cross Blue Shield of Michigan • Lansing, MI

36d

About The Position

SUMMARY: This Medical Bill Review & Compliance Advisor (MBR) role is responsible for the management of the vendors related to the medical bill review process as well as PPO network performance results. Performs analysis of trends to identify appropriate solutions and responses to positively impact loss costs and expense savings. Ensures adherence to compliance regulations by monitoring and providing oversight to all rules and regulations. Provide operational consistency and integrity as well as continuous quality improvement and maximum performance. Serve as a technical expert with regards to workers compensation medical spend strategy focused on enterprise bill review processes.

Requirements

• Bachelor’s degree in insurance, business, or a related field. Combinations of relevant education and experience many be considered in lieu of a degree, preference given to degree. Continuous learning required, as defined by the Company’s learning philosophy.
• Minimum of three (3) years experience in Workers Compensation.
• Minimum of three (3) years experience in medical bill review.
• Demonstrated technical knowledge in medical bill review software, PPO vendor processes, industry trends, compliance, medical terminology, anatomy, or similar knowledge that provides the necessary skills and abilities.
• Experience developing, analyzing, and assessing medical bill review performance metrics in a collaborative environment.
• Knowledge of contract language as it relates to medical bill review vendors and those associated with cost containment of medical expenses.
• Leadership skills with proven results related to execution and change management.
• Excellent analytical skills to identify improvement needs, develop solutions, and assess impact.
• Ability to interact with all levels of internal staff and management, and effectively exchange information clearly and concisely, present ideas, report facts and other information, as well as respond to questions as appropriate.
• Strong interpersonal skills and the ability to negotiate while creating and maintaining mutually beneficial relationships with working partners.
• Ability to manage multiple projects and meet necessary deadlines with minimal direction.
• Ability to perform necessary mathematical computations.
• Ability and proficiency in the use of computers and company standard software specific to position.
• Ability to make competent, strategic, and independent decisions.
• Ability to maintain confidentiality.

Responsibilities

• Assists Sr. MBR in the development and in the development and distribution of and shares reports around medical spend, operational performance and efficiencies, for marketing, new/renewing policies, and regulatory compliance.
• Constructs and prepares reports for Medical Bill Review leadership comparing results to established benchmarks and recommends process changes, as appropriate.
• Supports Sr. MBR in the management of enterprise medical bill review vendors and vendors associated with the medical cost containment programs.
• Monitors PPO/network vendor activity including compliance with contractual requirements, outcomes, savings, and penetration rates.
• Assists medical bill managers with implementation and monitoring of policies, practices, and procedures.
• Responds to special or specific audit and/or research requests.
• Performs special projects, as assigned
• Maintains confidentiality of all information processed.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 5,001-10,000 employees