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Using a systematic approach such as GRADE (or similar methodology), researches the substance of medical technology, for the production of Local Coverage Determinations (LCDs) and coverage analyses for Medicare for Durable Medical Equipment, Prosthetics, Orthotics and Supplies. Assists the DME MAC Medical Directors in composing or revising LCDs and coverage analyses and in finalizing the process fo
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This position will require to work year round in Birmingham, AL, which includes summer and academic school year. Intern position utilized for training an active college student towards a professional level role. Responsibilities vary and are based upon the needs of the area and the experience of the incumbent at the time of employment. This incumbent works under direct supervision and has responsi
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Plan, design, and develop complex and business critical software solutions, utilizing appropriate software development methodologies either individually or as part of a project team. Responsible for ensuring that browser based systems and applications meet client requirements and operate properly, using software development methodologies. Description 25% Develop functional design and technical s
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Develops difficult statistical analysis using standard reporting, AD HOC reporting, and data mining tools in order to identify patterns and trends. Prepares charts, illustrations, and other graphics and narrative reports to identify and explain data findings. Description 30% Develops, maintains, and executes complex database programs for the extraction and presentation of data for standard and a
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Responsible for providing a full range of financial, compliance, and operational audits, business advisory and consultation services, investigations, internal controls, accountability, and use of resources. Description 40% Conducts internal and external timely operational, compliance, and financial audits of divisions, departments, providers, and activities of the corporation including evaluati
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Performs medical reviews using clinical/medical information provided by physicians/providers and established criteria/protocol sets or clinical guidelines. Documents decisions using indicated protocol sets or clinical guidelines. Provides support and review of medical claims and utilization practices. Description Position will be onsite in Nashville, TN. Performs medical claim reviews for one or
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Develops and maintains internet content to effectively communicate with various audiences. Ensures online communications are in compliance with corporate standards of quality and association brand regulations. Description 70% Manages internet content through editing, proofreading, project troubleshooting, testing, research, and client liaison services. 20% Ensures all association branding regula
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Responsible for group and individual product sales and marketing/promoting products at events through the use of the BlueCross Mobile Unit. Provides sales and service to customers seeking insurance at community events. Responsible for set up and clean up of the Mobile Unit. Maintains current knowledge of all assigned insurance products. Customarily and regularly engaged in outside sales. Descript
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Assists in the development of employee compensation programs that support organizational objectives, fit organizational culture and facilitate attracting, retaining, rewarding high performance employees. Consults with HR and organizational management to provide compensation recommendations and options that align with the overall structure of the BCBSSC organization. Conducts analysis of job conten
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Develops difficult statistical analysis using standard reporting, AD HOC reporting, and data mining tools in order to identify patterns and trends. Prepares charts, illustrations, and other graphics and narrative reports to identify and explain data findings. Description 30% Develops, maintains, and executes complex database programs for the extraction and presentation of data for standard and a
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BlueCross BlueShield of South Carolina
- Charleston, SC / Columbia, SC / Birmingham, AL / 2 more...
Responsible for assisting in the execution of financial, compliance, and operational audits including evaluation of internal controls. Audits the activity of various departments and providers for compliance with plans, policies, and procedures prescribed by management. Reviews assigned portions of audit programs, determines compliance with policies and procedures, recommends corrective action plan
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BlueCross BlueShield of South Carolina
- Charleston, SC / Columbia, SC / Birmingham, AL / 2 more...
Responsible for providing a full range of financial, compliance, and operational audits, business advisory, and consultation services, investigations, internal controls, accountability, and use of resources. Description 50% Conducts internal and/or external timely operational, financial, and/or compliance audits of divisions, departments, providers, and activities of the corporation including ev
Posted Today
BlueCross BlueShield of South Carolina
- Charleston, SC / Columbia, SC / Birmingham, AL / 2 more...
Responsible for providing a full range of financial, compliance, and operational audits, business advisory, and consultation services, investigations, internal controls, accountability, and use of resources. Description 50% Conducts internal and/or external timely operational, financial, and/or compliance audits of divisions, departments, providers, and activities of the corporation including ev
Posted Today
Responsible for responding to customer inquiries. Inquiries may be non routine and require deviation from standard screens, scripts, and procedures. Performs research as needed to resolve inquiries. Reviews and adjudicates claims and/or non medical appeals. Determines whether to return, deny or pay claims following organizational policies and procedures. Description 45% Ensures effective custome
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Responsible for responding to routine correspondence and telephone inquiries pertaining to claims or appeals. Identifies incorrectly processed claims and completes adjustments and related reprocessing actions. Description 60% Researches and responds to telephone inquiries according to desk procedures, ensuring that contract standards and objectives for timeliness, productivity, and quality are m
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