Capital BlueCross (CBC), the leading health insurance company in the region, is committed to improving the health and well-being of our members and the communities in which they live. We are a member-focused health and medical value leader and we serve nearly 1 million members in a 21-county area in Central PA.
Headquartered in Harrisburg, Pa., this capital city offers something for everyone, including access to the outdoors, with mountains, rivers and streams close by, and shore points within a half day’s drive. Major east coast cities such as Philadelphia, New York, Baltimore, and Washington, D.C. are just a few hours away by car. The area is also bolstered by multiple colleges and universities offering top notch higher education. A lively arts scene is enjoyed in the Harrisburg area as well as a variety of family entertainment venues, including amusement parks and sports arenas that make the area an ideal location for families.
More than a health insurer, the company delivers innovative solutions through a family of diversified businesses that is creating a healthier future and lowering health care costs. Among these solutions are patient-focused care models, leading-edge data analytics, and digital health technologies.
This is an excellent career opportunity for an experienced manager to lead a Medical Policy and Corporate Coding unit.
This Manager provides strategic and operational direction to a staff of 12 professionals in our Medical Policy and Corporate Coding Unit activities. In collaboration with our Medical Directors, UR leaders, our Provider Network, IT and Product creation staff, you will help develop, maintain and implement well-defined medical necessity policy and coding in accordance with provider and member contracts, NCQA, CMS and the DOH. Projects are centered around coding, configuration assessments, utilization management, medical necessity policy and data accuracy. Will also help shape administrative efficiencies among team members.
Candidates must have 5+ years of coding and/or medical policy experience, in addition to 2+ years of supervisory experience in a corporate setting. Medical Coding Certification (professional and/or facility) is needed. A Bachelor's degree and LPN or RN are preferred. Must be familiar with NCQA standards, Medicare coding/reporting requirements and CMS regulatory requirements for health plans, and possess a broad and proven working knowledge of health insurance functions pertaining to utilization management, quality assurance, case management and disease management. Strong computer skills are also essential, including proficiency with Microsoft Office Suite (Word, Outlook, Excel, Access, Power Point, and Share Point), as well as strong electronic research skills.
This position requires the signing of Non-Competition, Non-Disclosure and Non-Solicitation Agreement.
We offer a highly competitive, market-driven compensation/benefits plan. Capital BlueCross is also committed to providing physical activity and wellness opportunities for our employees. We offer a convenient on-site fitness center, wellness incentives, and access to personal fitness training sessions to help employees meet their health goals. We have been recognized as a 2016 Platinum-Level Fit-Friendly Worksite by the American Heart Association and were named #3 on Training Magazine’s list of the top 125 globally ranked training programs.
Our innovative Capital Blue Health and Wellness Centers located in Enola and Center Valley provide in-person service and inspiration to help people reach their health goals. Each one is open to the public and includes a fitness studio, Healthy You Café and on-site care guides skilled in multiple areas, including nutrition and biometrics screening. Capital BlueCross employees can take advantage of the many services offered at Capital Blue at little to no cost.
Capital BlueCross is an independent licensee of the BlueCross BlueShield Association. We are an equal opportunity/affirmative action employer and do not discriminate on the basis of race, color, religion, national origin, gender, sexual orientation, gender identity, age, genetic information, physical or mental disability, veteran status, or marital status, or any other status protected by applicable law. We offer a highly competitive, market-driven compensation/benefits plan. Engage with us on LinkedIn, Twitter, Facebook or Instagram.