National Programs Analyst
About the role
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.
What You'll Do
- 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.
- Maintains compliance with various Association policies and procedures, coordinating training when required.
- Solves 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.
BLUE CARD SPECIFIC JOB TASKS
- 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.
Education/Experience
- A 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.
- Project management/data analysis experience preferred.
Why Horizon?
If you are passionate about making an impact, we’d love to hear from you!
Career Opportunities
Horizon offers 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
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware. 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.
Equal Opportunity 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.