Candidates must be in NY PA NJ DE CT
Candidates must be fully vaccinated
The Institutional Reimbursement Analyst II process inquiries initiated by hospitals and ancillary providers. The Institutional Reimbursement Analyst II represents Horizon-BCBSNJ with external and/or internal customers as a subject matter expert and reference point to providing resolution to difficult and complex matters. This position is responsible for claim adjustments, explaining denials and A/R reconciliations and developing process improvements to ensure continuous problems will be corrected. The position will act as a liaison between the Hospital Community including Horizon-BCBSNJ’s Alliance Partners, Network Hospital Relations, Ancillary Contracting, and Provider Services.
- Responsible for working directly with the Hospital Community to resolve outstanding accounts on first contact and determine action steps needed to provide the best service model.
- Review and compile monthly, quarterly, and annual reports on quality statistics in order to provide recommendations for process improvement and best practices.
- Partner with facility employees to identify and bridge financial gaps, i.e.; resolving open Accounts Receivables (ARs), claim payment issues, etc.
- Researches, recommends and develops procedural, systemic or other revisions to increase departmental efficiency, accuracy and productivity in service.
- Maintains thorough knowledge of all processing systems within Service. Review and adjust claims off site and in house as needed.
- Provide on-site support in Alliance Partner’s two to three times a week on an as needed basis. (Co-location has been replaced with standing conference calls and or web-ex meetings during COVID).
- Facilitate and participate in Hospital Seminars to ensure coverage of all current claim issues/concerns.
- Prefer a minimum of 1-2 years researching and investigating customer service inquiries.
- Strong Customer Service skills.
- Knowledge of claim processing systems. NASCO knowledge – preferred
- Strong PC Skills.
- Analytical Thinking, Critical Thinking, Organizational Skills and strong Written Communication Skills.
- Problem solver
- Strong organizational skills
- Active listening skills
- Requires knowledge of medical terminology
- Requires Good Oral and Written Communication skills
- Prefer the ability to analyze and resolve problems with minimal supervision
- Prefer the ability to use a personal computer and applicable software and systems
- Team Player, Strong Analytical, Interpersonal Skills
- Requires ability to make sound decisions under the direction of Supervisor
- Prefer knowledge Managed Care principles
- Prefer knowledge of contracts, enrollment, billing & claims coding/processing