Benefit Integrity Coordinator

Cahaba Safeguard Administrators, LLC is preparing for future business opportunities in your area.

 

About Our Company Cahaba Safeguard Administrators, LLC is a wholly owned subsidiary of Blue Cross and Blue Shield of Alabama that was created to administer the provisions of any task orders under the Medicare contract.

 

Department Overview The Cahaba Safeguard Administrators, LLC Benefit Integrity units identify, investigate and reduce fraud and abuse to the Medicare Program.  Benefit Integrity Investigations, Medical Review and Data Analysis partner to identify potential aberrancies that require further review to determine whether an actual loss to the Medicare Program has occurred.  Once a loss has been identified, the Benefit Integrity unit coordinates an appropriate response.

 

General Responsibilities

 This position coordinates, evaluates, investigates, and adjudicates high complex and priority cases, while providing guidance to investigators in detection of fraudulent activities involving Medicare funds.  The incumbent provides guidance for case development, as well as, coordinates and monitors all the Quality Improvement/Quality Assurance activities for investigators to identify opportunities for improvement and implement corrective action.  The incumbent also provides assistance, guidance and mentoring to the BI staff while also providing the initial and on-going training for said staff.  The incumbent must also have the ability to interpret CMS directives and be able to effectively implement these directives into the policies and procedures of the area.  The incumbent is charged with monitoring and detecting enhancements that may be made to the workflow process and work distribution as well as providing feedback to management concerning all areas of responsibility.

 

Qualifications

 1. Bachelor degree preferably in Business, Nursing and/or Law Enforcement
2. Minimum of three years fraud investigative experience or other related field
3. Minimum of two years experience in project management
4. Knowledge and/or experience with contract law and Medicare policy
5. Knowledge of Medicare claims processing and coverage guidelines
6. Experience in a position interpreting and communicating information orally and written
7.  Experience in a position utilizing Performance Management, leadership and/or team building skills
8. Experience in a position using negotiation skills
9. Experience in a position exercising independent judgment and decision making
10. Experience in a position requiring the ability to identify and solve problems
11. Experience using MS Word
12. Experience using MS Excel
13. Certified Fraud Examiner (CFE), preferred

 

Work Schedule

 The hours for this position are 8:00 a.m. to 4:45 p.m. Conditions of Employment Applicants selected for employment will be required to pass a pre-employment drug screening and background investigation which may include education, criminal, and work history verifications.

 

How To Apply

 Information about current career opportunities can be found on our web site at www.bcbsal.com.  Click on Careers.

To apply, build a profile online and attach your resume by registering with our website.  Click on the "Apply Now" button to login or register if this is your first time.

 

In Conclusion

 Thank you for your interest in Cahaba Safeguard Administrators, LLC.  We look forward to receiving your application.  Upon review, if you can be considered further you will be contacted by one of our Corporate Staffing representatives.

Again, thank you for your interest in our company.

Cahaba Safeguard Administrators, LLC is an affirmative action and equal opportunity employer.  As such, it is our policy to provide equal opportunity for all qualified persons and not discriminate against any associate or applicant for employment because of race, religion, color, sex, sexual orientation, age, national origin, handicap, disability, or  because he or she is a disabled veteran or a Vietnam Era Veteran.