• Job Description

  Req#: 2019-10004

  Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health. For over 90 years, we have been New Jersey’s health solutions leader driving innovations that improve health care quality, affordability, and member experience. Our members are our neighbors, our friends, and our families. It is this understanding that drives us to better serve and care for the 3.5 million people who place their trust in us. We pride ourselves on our best-in-class employees and strive to maintain an innovative and inclusive environment that allows them to thrive. When our employees bring their best and succeed, the Company succeeds.

  The Sr. Provider Field Claims Coordinator represents the Plan 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 Network Operations, Ancillary and Provider Services.

  • Responsible for working directly with the Provider Community to resolve outstanding accounts on first contact and determine action steps needed to provide the best service model.
  • Maintains thorough knowledge of all processing systems within service. Review and adjust claims and in house as needed. (Nasco)
  • Researches, recommends and develops procedural, systemic or other revisions to increase departmental efficiency, accuracy and productivity in service.
  • Responsible for logging and updating all cases in the Physician Services database. Also responsible for trending and providing analytical reports to Network Operations and/ or the Provider Community.
  • Responds to telephone calls and written inquiries that are received through the Provider Executive Case area.
  • Interfaces with other departments to assure consistent application of policies and procedures.

  
  

  Education/Experience:

  • Bachelor's degree preferred or equivalent work experience
  • Requires a minimum of 3 years experience in direct customer service and/or coordinating services with providers and health care institutions.

  
  Specialized knowledge/skills:

  • Must be able to process and adjust claims on Nasco.
  • Requires working knowledge of RCOE, UPS and New Membership.
  • Requires strong analytical and organizational skills.
  • Requires excellent oral and written communication skills.
  • Requires good interpersonal skills and the ability to interface with internal and external customers on a daily basis.

  Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware

  Salary Range:

  $49,400 - $66,045

  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:

  • Comprehensive health benefits (Medical/Dental/Vision)

  • Retirement Plans

  • Generous PTO

  • Incentive Plans

  • Wellness Programs

  • Paid Volunteer Time Off

  • Tuition Reimbursement

  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.

  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.

• About the company

  Horizon BCBSNJ offers affordable New Jersey healthcare and health insurance for individuals, families and employers. Find cheap NJ health insurance quotes online from Horizon BCBSNJ website, an independent licensee of the BCBS Association.

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