Provider Compliance Specialist

Blue Cross & Blue Shield of Mississippi • Flowood, MS

8d

About The Position

Healthy Careers Start Here At Blue Cross & Blue Shield of Mississippi, we encourage professional growth in a challenging and fast-paced atmosphere. Our 'be healthy' culture promotes health and wellness at all levels of the Company, and we provide our employees with the time, tools and resources to commit to a healthy lifestyle. The incumbent is responsible for supporting Provider Compliance’s fraud, waste and abuse detection and prevention activity through reviewing claims pended for fraud, waste and abuse review; conducting fraud, waste and abuse research and claims reviews on focus areas or aberrances, and preparing reporting on department fraud, waste and abuse related activity. The incumbent is responsible for monitoring the Company’s Fraud, Waste and Abuse hotlines, conducting research to resolve issues reported via the hotlines, and preparing reporting on Hotline activity.

Requirements

• A Bachelor’s Degree in a course of study which complements this position is required.
• Minimum GPA of 3.0 (on a 4.0 scale or equivalent measure).
• Minimum of two (2) years professional experience required; compliance, audit or healthcare related experience preferred.
• PC skills required to include the Microsoft Office Suite.
• Effective oral and written communications skills.

Nice To Haves

• Knowledge of Blue Cross & Blue Shield of Mississippi claims processing procedures and systems, including CAS, strongly preferred.

Responsibilities

• supporting Provider Compliance’s fraud, waste and abuse detection and prevention activity through reviewing claims pended for fraud, waste and abuse review
• conducting fraud, waste and abuse research and claims reviews on focus areas or aberrances
• preparing reporting on department fraud, waste and abuse related activity
• monitoring the Company’s Fraud, Waste and Abuse hotlines
• conducting research to resolve issues reported via the hotlines
• preparing reporting on Hotline activity

Benefits

• We offer a 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Number of Employees: 1,001-5,000 employees