Nurse Claims Review Coordinator - Remote

Blue Cross & Blue Shield of Kansas, Inc.; Topeka (KS); Hybrid; USD 86,000 - 107,000; Full time

Benefits offered by this job

Health insurance

Vision insurance

Dental insurance

6 weeks paid parental leave

Fertility/Adoption assistance

Tuition reimbursement

401(k) plan matching up to 5%

Wellness/fitness benefits

Job summary

Blue Cross and Blue Shield of Kansas seeks a Medical Review Claims Nurse Coordinator to supervise a team of nurse consultants and drive training initiatives. You will manage day-to-day operations, ensure regulatory compliance, and lead departmental projects with cross-divisional collaboration.

Ideal candidates bring a nursing background, a strong analytical approach, and experience in claims review. Remote/hybrid work is available with Kansas/Missouri residents considered for relocation.

Qualifications

• Bachelor's degree in nursing or health related field is required.
• Minimum 6 years nursing clinical experience is required.
• 3 years Medical Review Claims experience preferred.
• 1 year supervisory/leadership experience preferred.
• Current Kansas RN license required.
• AHIMA/AAPC coder certification within 3 years of hire required.

Responsibilities

• Oversee day-to-day activities of medical review nurse consultants.
• Lead cross-divisional meetings and coordinate training materials.
• Ensure employee production and quality meet department/company goals.
• Maintain records of hiring, firing and disciplinary actions.
• Ensure compliance with all regulations and URAC standards.
• Approve claims up to $1 million independently.
• Provide mentorship and staff development.

Skills

Supervise team

Analytical

Computer skills

Communication

Education

Bachelor's degree in nursing or health related field

Kansas RN License

AHIMA/AAPC coder certification

Job description

Blue Cross and Blue Shield of Kansas seeks a Medical Review Claims Nurse Coordinator to supervise a team of nurse consultants and drive training initiatives. You will manage day-to-day operations, ensure regulatory compliance, and lead departmental projects with cross-divisional collaboration.

Ideal candidates bring a nursing background, a strong analytical approach, and experience in claims review. Remote/hybrid work is available with Kansas/Missouri residents considered for relocation.