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BlueCross and BlueShield of TennesseeChattanooga, TNThe responsibility of the position is to supervise operational activities a Reconsideration Department.  The position is responsible to meet CMS workload requirements and to implement and maintain an effective QIC Appeals program as defined by CMS, which involves primarily meeting CMS standards for the timely and accurate review of the QIC appeals. Job Duties & Responsibilities: • Supervises the daily activities of clinical and or non-clinical staff working in the department. • Assigns daily workload to clinical and non-clinical staff and monitors team and individual progress to ensure timeliness and quality are being met. • Hires/motivates, and evaluates a diverse group of healthcare professionals and technical/support staff to assure effectiveness of operations and appropriate professional evaluation of DME appeals. • Monitors and maintains staff productivity and acts as a key resource to internal departments to maximize resource utilization (staff and equipment). • Provides and/or coordinates staff training for maximum performance and provides developmental opportunities. • Monitors performance of staff and takes action if necessary to provide additional training or discipline as appropriate • Supervises attendance, behavior, vacation, performance, and quality. • Promotes teamwork and positive working environment for staff. • Responsible for communication to staff established criteria, policies, procedures & changes as they occur • Develops and revises procedures for Medicare appeals and hearings and maintains all procedures ensuring all procedures are current. • Responds to inquiries from DME/MACs, providers and or beneficiaries in a timely, complete, and accurate manner. • Interacts with the Medical Director on department policy development and cases requiring direction from the Medical Director. • Interfaces with the Receipt and Control and Performance and Quality Departments • Stays current on all Medicare changes and mandates. • Assists with identifying training topics as well as aids in the training of new and existing employees. • Handles daily operational issues and problems independently with management direction, as needed. Education:• Registered Nurse, Clinical Para-professional (e.g., PT, OT, or RT) or Certified Coding Professional required.         o Registered Nurse or Clinical Para-professional requirements include a minimum of three years varied clinical experience, must have active license in the state of Tennessee; or, if Registered Nurse, must hold a license in the state of their residence if the state is participating in the Nurse Licensure Compact Law. Must be a graduate of an accredited nursing or para-professional program. Or,         o Certified Professional Coder (CPC) include a minimum of three years varied clinical, billing, or insurance experience. Must hold active certification from the American Academy of Professional Coders.• Bachelor's degree preferred or equivalent years of education and work experience.Experience:• Minimum of three year's supervisory experience required. • 18 months of Medical Review, Appeals, or coding experience required. • Medicare experience highly desired. • Must be PC literate with extensive knowledge of Windows and Microsoft Office. • Must possess excellent verbal and written communication skills with problem-solving abilities as well as organizational and interpersonal skills. • Must be able to work independently and handle multiple tasks. • DME experience strongly preferred. • Some travel, as necessary.Skills/Certifications:• Experience in quality management, process improvement, or clinical coding highly preferred. • Excellent grammatical and spelling skills. • Intermediate level or above MS Word and Excel skills.Please apply via our career site at:https://www.bcbst.com/about/careers/openings/