Medical Payment Specialist

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.

• Reviews and adjudicates complex medical bills in accordance with established policies and procedures.

• Posts approved bills for payment, and issues Explanation of Benefits (EOB) for denied payments.

• Responds to internal/external inquiries regarding the status of medical bills.

• Acts as information resource to Medical Consultants for policy determination.

• Assists in gathering/providing information for resolution of medical bill payment disputes and provider appeals.

• Completes other assigned functions as requested by Management.

• High School Diploma/GED required.

• Requires a minimum of 2-3 years of experience adjudicating medical bills.

• Prefer work experience in a property and casualty insurance environment.

Knowledge:

• Requires working knowledge of personal computers and supporting software in windows based environment including MS Office Products and email application systems.

• Requires knowledge of medical terminology.

• Requires knowledge of medical bill adjudication process.

• Requires knowledge of applicable laws and regulations regarding medical bill adjudication.

• Prefers knowledge of NJ Workers' Compensation and No-Fault laws.

Skills and Abilities:

• Requires strong mathematical skills.

• Attention to Detail

• Decision Making

• Communication & Organizational Skills

• Flexibility/Adaptability

• Planning/Priority Setting

• Teamwork

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

Salary Range:

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.