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Job no: 495172Blue Cross and Blue Shield of Nebraska (BCBSNE) is more than just an insurance company; we exist to be there for people in the best and hardest moments of their lives.Our team is the power behind that promise. And, as the industry rapidly evolves and we seek ways to optimize business processes and customer experiences, there's no greater time for forward-thinking professionals like you to join us in delivering on it!As a member of Team Blue, you'll find purpose, opportunities and the support you need to build a meaningful career and make a powerful impact in our community.This role is responsible for identifying and implementing all coding edits for the Company's claims processing system. This role will educate internal and external customers on appropriate billing and coding practices and policies. It will also analyze data related to billing and coding for reimbursement related polices.What you'll do:Provide information/documentation and support to implement coding edits for use in the Company's claims processing system.Review, edit, and maintain all current reimbursement policies, and develop any new reimbursement policies for the Company.Research and analyze claim data for inappropriate billing practices, inappropriate coding, and any other reimbursement methodology concerns. This will include investigation of APR-DRG's, CPT/HCPCS codes, Revenue Codes, ICD-10's, any potential Company auditor errors, any potential system errors, inappropriate application of benefits, or any other factors deemed necessary to appropriately adjudication claims.Identify and provide background information and analysis during annual reimbursement change/update process.Work collaboratively with Business Analytics, Provider Relations Managers, Special Investigations Unit, and other inter-department teams on a wide variety of reimbursement related projects.Keep abreast of changes to internal medical policy, benefit changes, reimbursement updates and coding/billing guidelines to be able to incorporate the most current information when working with providers and internal staff.Using oral and written communications skills to obtain and/or present information to internal staff and providers. Work with Medical Support and Medical Management on provider inquiries that relate to current or potential medical policies.To be considered for this position, you must have:Associate's Degree from an accredited college or university in healthcare, medical coding, accounting, finance, or a related field and three (3) years' experience in healthcare is required.Strong understanding of institutional, professional and ambulatory surgery reimbursement methodologies including CPT/HCPCS, RBRVS, APR-DRG's, and EAPG's.Intermediate to advanced Microsoft Office skills (Highest priority in Excel).Ability to pass necessary claims processing training required.Previous Medical Coding experience required.Learn more about what makes BCBSNE such an exceptional place to work by visiting strongly believe that diversity of experience, perspective and background will lead to a better workplace for our employees and a better product for our customers and members. Blue Cross and Blue Shield of Nebraska is an Equal Opportunity/Affirmative Action Employer - Minorities/Females/Disabled/Veterans