Blue Cross and Blue Shield of Mississippi
MS, USA
Job Description: This position is 100% on-site in Flowood, Mississippi Job Summary: The Senior Clinical Compliance Auditor serves as the primary clinical reviewer of data analysis findings, referrals, appeals and complaints related to Network Hospitals, Providers, Pharmacies, and other entities or programs suspected of inappropriate billing of claims to Blue Cross & Blue Shield of Mississippi. The incumbent is responsible for selecting, obtaining, coordinating, monitoring, and reviewing medical records and other relevant information for clinical and coding assessment and validation of related billing of services provided to Blue Cross Blue Shield Customers. The Senior Clinical Compliance Auditor collaborates with data analysts, compliance auditors, and the Medical Director to identify aberrant trends in patient care, utilization, and billing practices. The incumbent works with a multidisciplinary team to determine appropriate interventions to address and resolve identified...