Medical Policy Coordinator
Blue Cross Blue Shield Kansas

Job Info

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The Medical Policy Coordinator is responsible for researching and developing medical and dental policies (hereafter referred to as medical policies) recommended by the Blue Cross and Blue Shield of Kansas (BCBSKS) liaison committees, Medical Advisory Committee (MAC) and Dental Advisory Committee (DAC) and the internal Medical Directors. These policies are used to establish the contractually required medical necessity of procedures and services billed to the company on behalf of its members, publicly represent BCBSKS' position on the company's web site, and are used by external and internal customers.

"This position is eligible to work onsite 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."

Are you ready to make a difference? Choose to work for one of the most trusted companies in Kansas.

Why Join Us?

• 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.
  
• Dynamic Work Environment: Collaborate with a team of passionate and driven individuals.
  
• Trust: Work for one of the most trusted companies in Kansas
  
• Stability: 80 years of commitment, compassion and community
  
• Flexibility: options to work onsite or hybrid available
  
• Inclusive Work Environment: We pride ourselves on fostering a diverse and inclusive workplace where everyone is valued and respected.
  

Compensation

$72,000 - $86,000 annually

Exempt 15

• Blue Cross and Blue Shield of Kansas offers excellent competitive compensation with the goal of retaining and growing talented team members. The compensation 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 wages that align with the individual's skills, education, experience, and training. The range may vary above or below the stated amounts.
  

What you'll do

• Coordinate the day-to-day activities associated with the research, development, documentation and communication of liaison committee agendas and resulting medical policy. This includes working with any/all divisions within the company to develop creative ways to accomplish and maintain accurate medical policy.
  
• At the request of the VP of Medical Affairs / CMO, Medical Directors, and Supervisor research medical policy issues (including recommended new medical policies), prepare agendas, and determine cost impact, as needed, and presents research findings to Medical Directors at the Medical Policy Development meeting and subsequently to Medical Policy Team and to MAC, DAC for presentation to the Board of Directors.
  
• Using independent medical knowledge, researches and analyzes scientific literature, current standards of care, liaison and consultant input, procedure and diagnosis coding along with contractual language to develop new medical policy language and identification of potential experimental/investigational or unlabeled use services to determine medical policy position.
  
• Develop and maintain strong collaborative relationships with providers who are liaison members, BCBSA, other blues plans, vendors, and internal staff stakeholders to ensure medical policy criteria is accurate and complete and outcomes are met
  
• Ensure recommendations presented to MAC and DAC, and approved by the Board of Directors, are carried out without compromising Member and Provider satisfaction.
  
• Run utilization reports, conducts analysis of raw data to determine usage, successful medial policy implementation by identifying any improper claims payment, to include initiate audit of implemented medical policy, presents final report for management review
  
• Assure timely and accurate medical policy implementation to include publication, internal staff notification, and system updates along with educating and communicating to internal personnel decisions for new medical policies, medical policy updates, and liaison and consultant recommendations.
  
• Attend and participate in all liaison and advisory committee meetings, held throughout the state or at BCBSKS offices, for the review and discussion of medical policy with responsibility to assist in gaining consensus on policy contents which will require evenings/long hours and possible travel and overnight.
  
• Initiate and respond to surveys with other Plans and provider specialties concerning liaison committee agenda development, medical policy and related new technologies.
  
• Indirectly supervises and trains Liaison Specialist in addition to provides back up for Medical Policy Supervisor.
  
• Participate as an active member of the Claims Review Team, Educational Sessions Team, Preventative Task Force Team, BCBSKS/Prime MP Team and Codes R Us Team providing input on liaison committee decisions and medical policy updates.
  
• Maintain confidentiality of corporate and Blue Cross and Blue Shield Association proprietary information and documents and follow URAC standards as required for essential job functions.
  
  

Knowledge, Skills, and Abilities

• Excellent verbal and written communication skills, with the ability to effectively interact with all levels of corporate staff, other Blue's Plan staff, providers and vendors, to include facilitating discussion, problem solving, and conflict resolution required.
  
• Must be able to research clinical evidence, critically analyze, and present findings of scientific literature, medical journal publications, academy/society guidelines, expert consultant opinions, and clinical studies.
  
• Must be able to quickly and accurately respond to questions from internal and external customers.
  
• Ability to self-direct, be flexible, adaptable to ever changing timelines, and handle multiple assignments and projects simultaneously with demanding deadlines.
  
• Strong computer experience in the use of Microsoft, Internet, and other software applications for the purpose of research, analysis, and document development required.
  
• Must be knowledgeable of current medical practice and able to critically analyze multiple clinical and medical sources to formulate committee agendas and resulting medical policy.
  
• Research and development of agendas, medical policy, or other documents used for reference and decision making preferred.
  
• Experience collaborating with teams and/or project management preferred.
  

What you need

• Baccalaureate in Nursing with a minimum of five years clinical RN experience.
  
• Valid and current Kansas nursing license required.
  
• American Academy of Procedural Coders or equivalent certification for professional services within two years of hire, required.
  
• Experience with public speaking and leading meetings.
  

Physical Requirements

• Flexible work schedule required for Liaison and MAC/DAC meetings outside regular business hours.
  

Benefits & Perks

• 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
  

Our Commitment to Diversity, Equity, Inclusion, and Belonging

At Blue Cross and Blue Shield of Kansas, we are committed to fostering a culture of diversity, equity, inclusion, and belonging (DEIB), where mutual respect is at the foundation of our workplace. We provide equal employment opportunities to all individuals, regardless of race, color, religion, belief, sex, pregnancy (including childbirth, lactation, and related medical conditions), national origin, age, physical or mental disability, marital status, sexual orientation, gender identity, gender expression, genetic information (including characteristics and testing), military or veteran status, family or parental status, or any other characteristic protected by applicable law.

We believe that embracing diversity and authentically promoting inclusion, equity, and belonging among our team members is crucial to our collective success. By intentionally recruiting, developing, and retaining a diverse pool of talent, we cultivate an environment where everyone feels valued, heard, and empowered to contribute. Accommodations are available for applicants with disabilities upon request, ensuring an inclusive and accessible hiring process for all.

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