Blue Cross and Blue Shield of Louisiana

The MSP Specialist analyzes and resolves CMS Section 111 MSP Response File errors to ensure data exchange compliance. They are responsible for determining Medicare order of payment, processing Small Employer Exception approvals, and recovering overpayments.

Researches and verifies complex claims information to ensure accurate and timely processing. Identifies inconsistencies in claims documents and corrects them according to established guidelines and regulations.

Organize and provide care coordination and case management services for high-risk members to improve health and financial outcomes. Develop and implement comprehensive case management plans while collaborating with providers, families, and community resources.

Responsible for designing and executing enterprise legal hold and information governance capabilities to ensure defensible preservation and retention practices. The role involves managing the full legal hold lifecycle and partnering with Legal, IT, and Cybersecurity departments.

The Senior CDI Specialist ensures accurate and compliant clinical documentation to reflect severity of illness and support correct reimbursement. This role involves educating providers, conducting documentation reviews, and collaborating with population health teams to drive value-based care initiatives.