Medical Review Claims - CXT Analyst

The Medical Review Claims CXT Analyst is responsible and accountable for timely and accurate maintenance of Claims XTen (CXT) edits. Responsible for maintaining the CXT master spreadsheet. Responsible for assisting the claims analysts with non-clinical reviews of Blue Cross and Blue Shield, National & Special, State, Federal, ITS claims and CSC inquiries to support corporate timeline goals. Responsible for accurate and timely responses to internal and external inquiries involving requests for explanation of contract coverage, coding, claims payments, and CXT editing. Responsible for identifying aberrant provider activity and opportunities for provider education and refer for appropriate intervention.

“This position is eligible to work onsite, remote or hybrid (9 or more days a month on site) in accordance with our Telecommuting Policy. Applicants must reside in Kansas or Missouri or be willing to relocate as a condition of employment.”

• Make a Positive Impact: Your work will directly contribute to the health and well-being of Kansans.
• Family Comes First: Total rewards package that promotes the idea of family first for all employees.
• Professional Growth Opportunities: Advance your career with ongoing training and development programs.
• Stability: 80 years of commitment, compassion and community
• Flexibility: options to work onsite, hybrid or remote available
• Balance: paid vacation and sick leave with paid maternity and paternity available immediately upon hire

• Blue Cross and Blue Shield of Kansas offers excellent competitive compensation with the goal of retaining and growing talented team members. The salary range for this role is a good faith estimate, it is estimated based on what a successful candidate might be paid. All offers presented to candidates are carefully reviewed to ensure fair, equitable pay by offering competitive salaries that align with the individual's skills, education, experience, and training. The range may vary above or below the stated amounts.

• Responsible for assisting with the creation of CXT change requests.
• Responsible for maintaining the CXT master spreadsheet.
• Responsible for regular CXT edit testing.
• Responsible for assisting with the claim analyst team with independent non-clinical review of claims and inquiries using contracts, medical policies, internal guides, and desk process.
• Ensure claims and inquiries are processed timely and accurately according to contract, corporate, and federal guidelines.
• Responsible for researching history, identifying appropriate guidelines, and formatting clear concise question(s) for claims needing nurse, management, or outside consultant review.
• Responsible for providing support to internal staff (i.e., Marketing, Hotline, CSC), regarding questions about CXT processing.
• Responsible for maintaining current knowledge regarding coding, contract language, system editing, and pricing guidelines.
• Participates in department and cross-divisional teams.
• Must follow URAC standards as required for essential job functions.

• Must be able to comply with and implement corporate information security policies, standards, and guidelines relative to access control.
• Must be self-directed with the ability to make independent decisions and prioritize personal and employee production activities.
• Must have strong computer skills in order to operate effectively with company systems and programs.
• Proficient in Excel, WORD, OneNote, and other department used systems.
• Must be able to maintain a productive and professional relationship with multiple cross departmental and divisional teams.
• Must be able to maintain an excellent record of attendance.
• Must have a strong analytical background.
• Must be able to use medical terminology/medical diagnostic and procedure information, ICD-10, CPT, HCPCS coding to accurately review and complete claims activity.

• High school graduate or equivalent, required.
• At least three years of BCBSKS Claims or CSC experience AND/OR American Academy of Professional Coders certification with at least 2 years of coding experience or at least 3 years of medical coding experience, required.
• Thorough knowledge of multiple product lines, contracts, and related operating policies with preference to FEP, Blue Choice, State of Kansas, and Interplan Teleprocessing System (ITS), preferred.
• Thorough knowledge of CSI, Reimbursement Schedules, Ask Oz, ACEs, Claims XTen, Imaging, BlueConnect, and Outlook – preferred.
• CPC certified or obtain certification by American Academy of Professional Coders within three years of hire.

• 90-100% sedentary work setting using a computer.

• Base pay is only one component of your competitive Total Rewards package
• Incentive pay program (EPIP)
• Health/Vision/Dental insurance
• 6 weeks paid parental leave for new mothers and fathers
• Fertility/Adoption assistance
• 2 weeks paid caregiver leave
• 5% 401(k) plan matching
• Tuition reimbursement
• Health & fitness benefits, discounts and resources