Medicare Analyst

at  Horizon Blue Cross Blue Shield of New Jersey

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware
Job Summary:
This position is responsible for the ability to understand and abide by Federal Centers for Medicare and Medicaid Services guidance. Fast-paced environment with frequent priority changes. Organization and follow-up abilities will be critical. Policy and reconciles daily systemic eligibility discrepancies.

Responsibilities:

• Reconciliation of all daily, weekly and monthly Medicare reports generated from CMS as well as researching where required.
• Deadline sensitive information processing, including Quality Audit.
• Review and analysis of reporting to dictate daily/weekly priorities.
• Working within comprehensive understanding of several databases.
• Directly respond or support a response that is rapid and professional to internal and external customers, not limited to Medicare Beneficiaries, Federal Regulators, Executives and Congress persons.
• Generating and ensuring compliance and accuracy of various types of member correspondence.
• Reconciling eligibility discrepancies relying on your ability to arrive at a consistently compliant disposition after the analysis of information from several reference-guidance, Call Center notes, multiple databases, and telephone outreach.
• Inventory control responsibility.
• Identification and communication of processing performance opportunities.
• Performs other duties as assigned by management.

Addendum: Premium Billing

• Responsible for successful administration of the delinquency outreach program for assigned members who are not current in their premium payment
• Responsible for review, reconciliation to member premium bills and financial accounts.

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:

• High School Diploma/GED required
• Requires a minimum of three (3) years experience in Health Insurance or a related Medicare experience.

Knowledge:

• Requires detailed knowledge of system development life cycle and implementation methodologies.
• Requires excellent proficiency in structured query languages, analysis techniques and Access database.
• Has played a key role in major company initiatives and demonstrated some leadership experience.
• Has proven knowledge and experience with to translate CMS regulatory guidance.

Skills and Abilities:

• Requires excellent written and oral communication skills.
• Requires the ability to communicate in a clear and concise manner.
• Require strong PC skills including spreadsheets and word documents.
• Requires excellent organizational skills.
• Requires working knowledge of programming, development, and technical architecture.
• Requires conflict resolution and problem solving skills.

Salary Range:
$54,600 - $73,080

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

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

• Reconciliation of all daily, weekly and monthly Medicare reports generated from CMS as well as researching where required.
• Deadline sensitive information processing, including Quality Audit.
• Review and analysis of reporting to dictate daily/weekly priorities.
• Working within comprehensive understanding of several databases.
• Directly respond or support a response that is rapid and professional to internal and external customers, not limited to Medicare Beneficiaries, Federal Regulators, Executives and Congress persons.
• Generating and ensuring compliance and accuracy of various types of member correspondence.
• Reconciling eligibility discrepancies relying on your ability to arrive at a consistently compliant disposition after the analysis of information from several reference-guidance, Call Center notes, multiple databases, and telephone outreach.
• Inventory control responsibility.
• Identification and communication of processing performance opportunities.
• Performs other duties as assigned by management