We are seeking an experienced Senior Business Analyst - Medical Coding Configuration to support Medicaid claims processing and payment integrity initiatives. This role focuses on analyzing, configuring, and maintaining medical coding and claims editing rules that drive claim adjudication outcomes, including payment, denial, and pended claim scenarios. The ideal candidate will have deep expertise in healthcare claims processing, medical coding methodologies, and claims editing configuration, with hands-on experience in Optum CES (Claims Editing System) and/or FACETS.
Conducts in-depth research and analysis.
Identifies trends, emerging issues and recommends best practices to ensure maximum results and develops metrics.
Documents metrics and process changes.
Effectively analyzes, designs, develops, tests, debugs, implements, maintains and/or enhances new or existing systems through reporting and documentation.
Participate in and coordinate individual projects and related activities to ensure project progresses on schedule.
Maintains adequate communication regarding project status, risks, issues, and priorities with project sponsors and leadership.
Acts as a liaison with internal partners and external partners to identify opportunities and needs and researches/develops implementation plans for meeting these needs.
Responsible for representing the customer and/or stakeholder (internal/external) while collaborating with business and technical units.
Serves as senior subject matter expert associated with content, processes, and procedures.
May lead project teams and may provide training to lower level staff to achieve project milestones and objectives.
Performs additional responsibilities consistent with the scope and level of the role, as assigned.
5+ years of related information technology professional experience.
Bachelor's degree; in lieu of a degree, an additional two years of relevant experience beyond the qualifications listed above may be accepted.
Hybrid
$90,800.00 - $120,300.00 - $149,800.00 Annual
Pay is based on several factors which vary based on position, including skills, ability, and knowledge the selected individual is bringing to the specific job.
We offer a comprehensive benefits package which may include:
To discover more about what we have to offer, please review our benefits page.
At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. Blue Cross of Minnesota is an Equal Opportunity Employer and maintains an Affirmative Action plan, as required by Minnesota law applicable to state contractors. All qualified applications will receive consideration for employment without regard to, and will not be discriminated against based on any legally protected characteristic.
Individuals with a disability who need a reasonable accommodation in order to apply, please contact us at: talent.acquisition@bluecrossmn.com.
Senior Medical Coding Analyst • Saint Paul, MN, United States
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