Provider Tech Sppt Analyst II - NovaWell

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

8d•$63,000 - $84,420

About The Position

This position supports Network Data Management and departments that use provider data, including screening provider loading and coordinating procedural aspects of Government Programs provider systems. It helps maintain accurate, complete, and timely Government Programs provider data files; investigates and resolves data integrity issues; supports system enhancements and testing; and handles sensitive projects and priorities requiring close attention. The role also contributes to operational improvements, departmental reporting, vendor audits, and workgroups or committees.

Requirements

High School Diploma or GED.
At least 5 years of relevant work experience in provider data management in healthcare or insurance.
Proficiency with personal computers and supporting software in a Windows-based environment, including Microsoft Word, Excel, PowerPoint, and Outlook; familiarity with intranet and internet applications.
Excellent attention to detail and analytical abilities, including accurately reporting findings.
Excellent oral and written communication skills.
Ability to interact with personnel and management at all levels.
Ability to organize and prioritize work assignments.
Ability to work independently and exercise sound business judgment.

Nice To Haves

Knowledge of healthcare provider systems and claims processing systems.
Understanding of managed care and indemnity business models and operations.
Familiarity with provider credentialing processes, provider data integration, system enhancement projects, and testing methodologies.
Knowledge of medical terminology and healthcare procedures.
Experience supporting vendor audits, compliance activities, or operational reporting.
Use of AI tools to support operational efficiency.
Ability to understand medical terminology and medical procedures.

Responsibilities

Assist with direction and supervision activities for the Provider File Area to ensure accurate, complete, and timely maintenance of Government Programs provider data files.
Resolve provider data errors by identifying causes, recommending improvements, documenting strengths and best practices, and investigating incidents that affect data integrity and programs.
Assist in preparing, developing, and analyzing specifications for system enhancements and modifications so provider files integrate with current and planned systems.
Develop specifications and user testing criteria and obtain appropriate documentation to help ensure accurate provider data.
Evaluate and recommend improvements to operating procedures to enhance efficiency and controls.
Handle important or sensitive projects and priorities requiring a high degree of attention.
Produce departmental quality and production reporting, including vendor audits.
Represent the department on workgroups and committees.
Perform other duties as assigned by management.