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Contract Reimbursement Analyst

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POST DATE 8/23/2016
END DATE 10/24/2016

Horizon Blue Cross Blue Shield of New Jersey Ewing, NJ

Company
Horizon Blue Cross Blue Shield of New Jersey
Job Classification
Full Time
Company Ref #
MAS082016-07949
Location
Ewing, NJ
Experience
Mid-Career (2 - 15 years)
Job Type
Regular
Education
Bachelors Degree
AJE Ref #
575959525

JOB DESCRIPTION

Job Summary:

This position is responsible for assisting in the daily support and administration of reimbursement system(s) for participating physicians, acute care hospitals and ancillary institutional providers. Incumbent is accountable for review, analysis and implementing processing systems enhancements, and recommendations of business solutions. Also assists with quantitative and qualitative analysis to detect claims problems and recommend viable solutions. Additionally, coordinates the processing of special provides claims through appropriate channels.

Responsibilities:

* Preform and assist with quantitative and qualitative analysis to detect system problems and recommend viable solution, interim alternatives and documentation of processing irregularities.

* Review claim payments to ensure contract implementation are correct.

* Monitor assigned tasks to ensure meeting of implementation dates, quality, operational effectiveness and adherence to policy and standards.

* Preforms other duties as required by management.

* Other projects as assigned by manager.

Education/Experience:

* Requires a bachelor's degree from an accredited college or university, preferably with additional certification in computer science or equivalent work experience.

* Prefers a minimum of two (2) years professional experience in financial analysis and data reporting, health related auditing and or accounting in a health care environment.

Knowledge:

* Requires knowledge of health insurance products and services.

* Requires knowledge of health contracts.

* Strongly prefer provider claims processing experience.

* Must be proficient in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, Access, PowerPoint) and Lotus Notes; Should be knowledgeable in the use of intranet and internet applications.

Skills and Abilities:

* Must have effective verbal and written communication skills and demonstrate the ability to work well within a team. Demonstrated ability to deliver highly technical information to less technical individuals.

* Must demonstrate professional and ethical business practices, adherence to company standards, and a commitment to personal and professional development.

* Proven time management skills are necessary.

* Proven ability to exercise sound judgment and strong problem solving skills.

* Must be client service focused with effective ability to empathize.

* Must be detail oriented with strong organizational and data processing skills. Proven ability to follow detailed instructions is essential, along with proven problem solving skills.

* Proven analytical, research and problem solving skills a must.

* Must demonstrate the ability to learn quickly and apply learning to new situations. Must exhibit flexibility to change as appropriate.

Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law.

Requirements:

Education
Bachelors

Job Level
Individual Contributor

Expertise
Other

Job Type
Full Time

Location
Ewing, NJ