National Programs Analyst

Horizon Blue Cross Blue Shield of New Jersey•Newark, NJ

5d•$63,000 - $84,420

About The Position

This position is responsible for coordinating the implementation of various Association initiatives and projects to support the strategic and operations goals aligned to the IPP Scorecard. The incumbent will work with all levels of management to ensure business objectives are met and processes are implemented.

Requirements

High School Diploma/GED required.
Requires a minimum of 2 years of experience in a relevant field, preferably in operations, and or claims processing environment.

Nice To Haves

Project management/data analysis experience preferred.

Responsibilities

Provide business requirements, create action plans, and implement new and updated workflows in response to Blue Cross Blue Shield Association audit findings, Association mandates, and enterprise projects.
Consistently monitors various Association policies and procedures to ensure compliance, coordinating training when required.
Resolves common, complex and escalated issues directly impacting provider and member claims by working with other BCBS Health Care Plans, our members or providers.
Identifies operational issues and initiates fixes to eliminate trends of untimely, inaccurate, non-compliant or inconsistent claims adjudication for our participating providers or partner BCBS Health Care Plans involving multiple system and inquiry platforms.
Partners with IT on the implementation of all systemic solutions, performing user acceptance testing where appropriate.
Acts as a liaison between internal divisions and the BCBSA, coordinating National Programs compliance activities aligned to the guidelines of the Association.
Reviews provider files, working directly with IT and other internal partners to correct any issues identified by the BCBSA.
Participates in workgroups hosted by the BCBSA and represents Service Operations on all mandate calls.
Ensures that all Blue Card mandates are successfully implemented on time.
Manages the bulk adjustment process to ensure the identified claims to be adjusted are valid, provides specific bulk adjustment requirements and reviews and approves all mock adjustments.
Responsible for managing error reports coming from the BCBSA, including working with our IT partners to ensure that root causes are identified and remediated and initiating systemic solutions when required.
Manages open inventory with partner plans and internal stakeholders.
Works directly with the IT department, analyzing invalid BlueCard records and submitting work orders to correct the issue.
Develops all reporting requirements for BlueCard inventory.