Provider Tech Sppt Analyst II - NovaWell

Horizon Blue Cross Blue Shield of New Jersey is hiring a Provider Tech Support Analyst II to support Network Data Management and departments using provider data. The role focuses on maintaining accurate Government Programs provider files, investigating data issues, supporting system enhancements and testing, and producing quality and production reporting.

Responsibilities

• Assists with the direction and supervision activities of the Provider File Area to ensure the accurate, complete and timely maintenance of the Government Programs provider data files
• Resolve provider data errors by identifying causation and recommend improvements, identifying strengths and documenting best practices. Investigates all incidents impacting the data integrity and programs to allow for analysis of trends and potential vulnerability
• Assist in the preparation, development and analysis of specifications for system enhancements and modifications to ensure provider files integrate properly with current and planned systems
• Produces and develops specifications and user testing criteria while securing appropriate documentation to assure accurate data in file
• Evaluate and recommend improvements to specific current operating procedures to enhance operating efficiencies and controls
• Handle important or sensitive projects and priorities that require a high degree of attention
• Produce departmental reporting for quality and production, including vendor audits
• Provide departmental representation on workgroups and committees

Preferred

• 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
• Prefer the ability to understand medical terminology and medical procedures
• Healthcare Provider Systems
• Claims Processing Systems
• Managed Care Operations
• Indemnity Business Models
• Provider Credentialing
• Provider Data Integration
• System Enhancement Projects
• Testing Methodologies
• Medical Terminology
• Healthcare Procedures
• Vendor Audits
• Compliance Activities
• Operational Reporting
• Operational Efficiency

Benefits

• Comprehensive health benefits (Medical/Dental/Vision)
• Retirement Plans
• Generous PTO
• Incentive Plans
• Wellness Programs
• Paid Volunteer Time Off
• Tuition Reimbursement
• Remote work in Newark, NJ or Hopewell, NJ

Company

• New Jersey health insurer offering medical, dental, vision, prescription coverage
• Newark, New Jersey, USA
• http://www.horizonblue.com/
• Founded in 1932
• 5001-10000 employees

Qualifications

• High School Diploma/GED required
• Minimum of 5 years relevant work experience in provider data management in Healthcare/ insurance is required
• Must be proficient in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint) and Outlook; should be knowledgeable in the use of intranet and internet applications
• Requires excellent attention to detail
• Requires excellent analytical abilities and the ability to report findings accurately
• Requires excellent oral and written communication skills
• Requires the ability to interact with all levels of personnel and management
• Requires the ability to organize and prioritize work assignments
• Requires the ability to work independently and exercise sound business judgment
• 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
• Prefer the ability to understand medical terminology and medical procedures
• Minimum of 5 years relevant work experience in provider data management in Healthcare/ insurance is required.

Required skills

• Claims Processing Systems, Compliance Activities, Healthcare Provider Systems, Managed Care, Medical Procedures, Medical Terminology, Microsoft Office, Provider Credentialing, Provider Data Integration, Provider Data Management, Testing Methodologies, Vendor Audits

Preferred skills

• Knowledge of medical terminology and healthcare procedures, Use of AI tools to support operational efficiency

Experience

• 5+ years