Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware
Job Summary:
This position is responsible for the assignment of standard network rates and the maintenance of standard contract rates and demographic information. Performs root cause analysis for appeals and rate issues.Responsibilities:
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Loads all pricing requests for hospital, ancillary contracts and problems specific to pricing.
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Analyzes new CPT codes to calculate and assign network rates.
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Analyzes and performs root cause analysis on the error trends identified from focus audits/appeals as it relates to claims processing.
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Performs analysis necessary to document system problems and recommend viable solutions, including intermediate workarounds.
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Updates system files to reflect new group business and benefit changes for existing business.
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Performs quality audits on system file updates, rate uploads, and group paperwork.
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Other duties as assigned.
Disclaimer:
This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job.
Education/Experience:
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High School Diploma/GED required.
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Requires minimum of 2 years business experience, preferably in a workers compensation environment.
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Prefers prior experience in a medical billing environment.
Knowledge:
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Requires proficiency in the use of personal computers and supporting software in a Windows based environment, including MS Office products (to include advanced Access) and Lotus Notes; should be knowledgeable in the use of intranet and internet applications.
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Prefers knowledge of data analysis.
Skills and Abilities:
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Analytical and Problem Solving
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Attention to Detail
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Decision Making
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Information Gathering
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Team Player
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Time Management
Salary Range:
$61,200 - $81,900
This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This range has been created in good faith based on information known to Horizon at the time of posting. Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes:
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Comprehensive health benefits (Medical/Dental/Vision)
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Retirement Plans
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Generous PTO
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Incentive Plans
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Wellness Programs
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Paid Volunteer Time Off
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Tuition Reimbursement
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. Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.
Top Skills
What We Do
Horizon Blue Cross Blue Shield of New Jersey- the state’s largest and oldest health insurer - is a subsidiary of Horizon Mutual Holdings, Inc., a not-for-profit mutual holding company.
Together with its affiliates, Horizon provides a wide array of medical, dental, vision and prescription insurance products and services. As New Jersey’ health solutions leader, Horizon is transforming healthcare by working with doctors and hospitals to deliver innovative, patient-centered programs that improve quality and lower costs. It is headquartered in Newark, NJ with offices in Wall and Hopewell, NJ.
Horizon serves 3.7 million members including more than 1 million who rely on Medicaid for their health coverage.
