Medical Director Sr Payment Integrity
Eagan, MN 
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Posted 1 day ago
Job Description

About Blue Cross

At Blue Cross, we understand the importance of finding a job that you truly enjoy - at a company that shares your values. We've made it easy to feel good about working at Blue Cross by encouraging volunteerism, valuing diversity and offering the flexibility you need to live a balanced life. We offer a suite of comprehensive medical and dental benefits as well as competitive pay, flexible work schedules and generous personal paid time off in addition to 20 hours of volunteer paid time off each year. We look forward to serving Minnesotans over the next 80 years and beyond. Join us and make a healthy difference through the work you do every day.

Blue Cross and Blue Shield of Minnesota is one of the most recognized and trusted health care brands in the world with 2.9 million members. We're committed to reinventing health care to improve health for our members and the community. We hope you'll join us.

How Is This Role Important to Our Work?

This position will be a member of the Payment Integrity team, to provide leadership, organization and direction for all medical aspects of the suite of payment integrity programs and services. This role will also provide direction and oversight in the development and implementation of new programs and rules including clinical and coding guidelines for Payment Integrity services. This role will represent payment integrity to vendor programs and serve as a liaison among internal departments, external customers and providers on payment integrity initiatives and audit results. The role will also help to develop effective, well-defined and supported processes and functions for purchaser populations, and will develop, in collaboration with the full payment integrity team, new programs and concept management to meet Payment Integrity goals.

A Day in the Life:
  • Perform medical director auditing of claims referrals for potential recoupment or denial, providing clear rational for decision
  • Provide medical consultation and review of new concepts for potential waste and abuse
  • Provide clinical leadership oversight to vendor products
  • Develop and implement new coding and clinical programs and rules within payment integrity
  • Consult with medical directors on new opportunities
  • Participate in sales presentations and RFP's
  • Spokesperson for Payment Integrity programs to external departments, providers, and other plans
Required Skills and Experiences:

Accepting this director level position at BCBSMN requires signing an Employee Confidentiality, Intellectual Property.

Assignment and Restrictive Covenants Agreement as a condition of employment.

  • Board certification in Internal Medicine, Family Practice, General Surgery or appropriate area.
  • Unencumbered license to practice medicine in Minnesota.
  • At minimum, 5 years clinical experience plus 5 years administrative or managed care experience including utilization management and or payment integrity
  • Demonstrated success in driving new business, account retention and customer satisfaction
  • Proficient in leading discussions and public speaking with large and small groups
  • A highly professional, approachable and engaging communication and work style that engenders trust, credibility and collegiality
  • Demonstrated track record of utilizing data driven analysis to create actionable solutions
  • Ability to understand metrics at granular levels and in-depth experience with data, health care economics and reporting

Make a difference

Thank you for your interest in Blue Cross. Be part of a company that lets you be you - and make a healthy difference in people's lives every day

Blue Cross is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, or any other legally protected characteristic.

Reasonable Accommodation for Job Seekers with a Disability: If you require reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to talent.acquisition@bluecrossmn.com.

Blue Cross and Blue Shield of Minnesota and Blue Plus are nonprofit independent licensees of the Blue Cross and Blue Shield Association.


Blue Cross and Blue Shield of Minnesota is an Equal Opportunity and Affirmative Action employer that values diversity. All qualified applicants will receive consideration for employment without regard to, and will not be discriminated against based on race, color, creed, religion, sex, national origin, genetic information, marital status, status with regard to public assistance, disability, age, veteran status, sexual orientation, gender identity, or any other legally protected characteristic.

 

Job Summary
Start Date
As soon as possible
Employment Term and Type
Regular, Full Time
Required Experience
5 years
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