Payment Compliance Specialist

Blue Cross and Blue Shield of Kansas City(24 days ago)

Baltimore, MD, Kansas City, MOOnsiteFull TimeMedior$66,221 - $89,844 (estimated)Special Investigations Unit (Payment Compliance)

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About this role

The Payment Compliance Specialist is a member of Blue KC’s Special Investigation Unit focused on ensuring payment integrity by validating clinical documentation, coding, and billing for medical claims. The role supports fraud, waste, and abuse detection efforts, contributes to program reporting, and represents the SIU with internal and external stakeholders. It helps maintain compliance with payer policies and regulatory standards.

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Required Skills

Medical Coding
Coding Audits
Data Analysis
Investigations
Case Management
Report Writing
Provider Education
Claims Adjudication
Fraud Detection
Medical Review

Qualifications

AAPC CPC
AHIMA
Associates Degree
Certified Fraud Examiner (CFE)
Accredited Healthcare Fraud Investigator (AHFI)
Registered Nurse (RN)
Licensed Practical Nurse (LPN)

About Blue Cross and Blue Shield of Kansas City

bluekc.com

Blue Cross and Blue Shield of Kansas City (Blue KC) is a health insurance provider dedicated to offering comprehensive health plans for individuals, families, and groups. With a focus on helping members live healthy and fearless lives, Blue KC provides a range of coverage options tailored to meet diverse needs. The company prides itself on being a trusted partner in health, renowned for its commitment to service and community engagement in the Kansas City area.

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