We take great strides to ensure our employees have the resources to live well, be healthy, continue learning, develop skills, grow professionally and serve our local communities. We invite you to apply for a career with Blue Cross.
Residency in or relocation to Louisiana is preferred for all positions.
POSITION PURPOSEThis position is responsible for medical record chart retrieval on between Blue Cross Blue Shield of Louisiana and medical services providers as well as performing QA reviews on medical records per CMS, HHS protocol and NCQA guidelines. Accountable for complying with all laws, regulations and accreditation standards that are associated with duties and responsibilities.
NATURE AND SCOPE- This role does not manage people
- This role reports to this job: Departmental Leadership
- Necessary Contacts: In order to effectively fulfill this position the incumbent must be in contact with:
All levels of BCBSLA personnel; physicians and their office personnel; hospitals and allied health provider administration, personnel and third party medical record vendors ; other Blue Plans; BCBS Association and contracted vendors.
QUALIFICATIONSEducation- High School Diploma required
Work Experience- Minimum of 2 years of experience in reviewing / retrieving records for Risk Adjustment, and HEDIS projects required
- CMS and HHS medical records review protocol guidance and/ or measure guidance for NCQA measures experience required. Experience doing medical records scheduling, coordination and retrieval, medical office administrative assistant, or other customer-facing experience.
Skills and Abilities- Must have the ability to travel up to 40% of the time to provider offices as directed by management
- Must have excellent PC skills, including MS Word, Outlook PowerPoint, and advanced Excel.
- Excellent verbal and written communication skills are required.
- Understanding of risk adjustment and/or HEDIS
Licenses and Certifications ACCOUNTABILITIES AND ESSENTIAL FUNCTIONS- Queries and identifies relevant medical records within (but not limited to) document management system, care management system, and vendor(s) databases to be uploaded into BCBSLA databases.
- Handles telephone, email, and fax communication with provider offices and vendors to retrieve medical records and setup onsite medical records visits.
- Documents conversations with provider offices and vendors, and tracks outcomes. Scans and tags medical records into document management system.
- Perform onsite medical record review and abstract needed information to be uploaded into BCBSLA database.
- Coordinate medical records request with the Blue Cross Blue Shield Association for all out of state medical record request
- Perform QA Reviews on all medical records to ensure records meet CMS and HHS documentation requirements as well as retrieve medical records that meet specific NCQA requirements.
Additional Accountabilities and Essential FunctionsThe Physical Demands described here are representative of those that must be met by an employee to successfully perform the Accountabilities and Essential Functions of the job. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions- Perform other job-related duties as assigned, within your scope of responsibilities.
- Job duties are performed in a normal and clean office environment with normal noise levels.
- Work is predominately done while standing or sitting.
- The ability to comprehend, document, calculate, visualize, and analyze are required.
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An Equal Opportunity Employer
All BCBSLA EMPLOYEES please apply through Workday Careers.
PLEASE USE A WEB BROWSER OTHER THAN INTERNET EXPLORER IF YOU ENCOUNTER ISSUES (CHROME, FIREFOX, SAFARI)
Additional Information
Please be sure to monitor your email frequently for communications you may receive during the recruiting process. Due to the high volume of applications we receive, only those most qualified will be contacted. To monitor the status of your application, please visit the "My Applications" section in the Candidate Home section of your Workday account.
If you are an individual with a disability and require a reasonable accommodation to complete an application, please contact recruiting@bcbsla.com for assistance.
In support of our mission to improve the health and lives of Louisianians, Blue Cross encourages the good health of its employees and visitors. We want to ensure that our employees have a work environment that will optimize personal health and well-being. Due to the acknowledged hazards from exposure to environmental tobacco smoke, and in order to promote good health, our company properties are smoke and tobacco free.
Blue Cross and Blue Shield of Louisiana performs background and pre-employment drug screening after an offer has been extended and prior to hire for all positions. As part of this process records may be verified and information checked with agencies including but not limited to the Social Security Administration, criminal courts, federal, state, and county repositories of criminal records, Department of Motor Vehicles and credit bureaus. Pursuant with sec 1033 of the Violent Crime Control and Law Enforcement Act of 1994, individuals who have been convicted of a felony crime involving dishonesty or breach of trust are prohibited from working in the insurance industry unless they obtain written consent from their state insurance commissioner.
Additionally, Blue Cross and Blue Shield of Louisiana is a Drug Free Workplace. A pre-employment drug screen will be required and any offer is contingent upon satisfactory drug testing results.