Reimbursement Configuration Analyst I
Full Time
Newark, NJ 07105
Posted
Job description
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware
Job Summary:
Responsible for the accurate and timely configuration and maintenance of provider reimbursement arrangements for healthcare professionals, institutions and ancillaries.
Responsibilities:
- Interpret company reimbursement arrangements for healthcare professionals, Institutions and ancillaries.
- Consults with relevant contract manager or reimbursement lead to determine appropriate interpretation and configuration of contract terms
- Unit test simple configuration changes to ensure accuracy of rate load.
- Respond to internal and external provider fee requests.
- Performs problem resolution of configuration issues identified by the Service division or Provider Relations area
- Monitors and tests the accuracy of price rules, fee schedules, contract loads as assigned
- Assists with audit function to support both internal and external audits required by the company (SOX, SSAE16).
- Assist the Leads in the implementation of enterprise initiatives impacting pricing
- Understanding of medical terminology, medical coding (CPT4, ICD9/ICD10, and HCPCS), provider contract concepts and common claims processing/resolution practices
The information above is intended to describe the general nature of the work being performed by each incumbent assigned to this position. This job description is not designed to be an exhaustive list of all responsibilities, duties, and skills required of each incumbent.
Education/Experience:
- Bachelor's degree preferred with a preference in Accounting, Finance or Mathematics. In lieu of degree, relevant work experience required.
- Requires 3-5 years of Health Care experience specifically in provider contract and pricing configuration
- In lieu of degree, requires 5 years of Health Care experience, specifically in provider contract and pricing configuration
- Requires prior experience in one or more claim systems.
- Requires experience with pricing and / or provider contract arrangements
- Prefers experience with NetworX Pricer and NetworX PBA
- Prefers knowledge of one or more claim system with preference in claims processing, pricing and contract set up.
Knowledge:
- Prefers knowledge of business and technical requirements
- Prefer Claims processing systems knowledge
- Prefer knowledge of testing life cycle
- Working knowledge of MS tools, including MS Office products, MS Access, SQL Server.
Skills and Abilities:
- Excellent Communication and presentation skills (Verbal and written) since this is a direct business facing role.
- Must be client service focused with effective ability to empathize.
- Needs to demonstrate willingness to cross-train, and be cross-trained, in other roles/duties.
- 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.
- Exhibits an energetic, inquisitive, positive approach to problem solving.
- Ability to maintain attendance to support required quality and quantity of work
- Multi-tasking skills and planning for prioritizing workload
Travel (If Applicable):
- Not Required
Salary Range:
$67,100 - $89,880
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.
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