Administrative Appeals Coord

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

Job Summary:

This position is responsible for the efficient functioning of the Appeals Resolution Department, which prepares the incoming administrative claim appeals for resolution, for Horizon Medicaid Operations, ensuring that timeliness guidelines and accuracy standards are met.Responsibilities:

• Counts and logs member and claim data received on the appeal correspondence generate the appeal claim identification number and creates appeal file.

• Assist claim appeal analyst with retrieving completed files.

• Responds to claim appeal telephone inquiries received on the Claim Appeal Hotline.

• Maintain neat and orderly completed files in filing cabinets.

• Creates Overturn Report for claims processing.

• Educates providers and billing agencies on the Medicaid Operations appeal processes.

• Proactively recommends improved business processes.

• Other duties as assigned.

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.

Education/Experience:

• High School Diploma/GED required.

• Requires a minimum of one year customer service and/or healthcare experience, preferably in a Health Maintenance Organization and/or Managed Care environment.

• Prefers one year experience in the research of complaints or appeals.

Knowledge:

• Prefers knowledge of Medicaid Managed Care and Traditional/Indemnity insurance industries.

• Prefers knowledge of medical terminology.

Skills and Abilities:

• Requires strong verbal and written communication skills.

• Requires prior experience with Microsoft Office (Excel, and Microsoft Word) applications.

• Requires interpersonal skills.

• Requires strong organizational skills

• Ability to multitask.

• Requires strong telephone/interpersonal skills, strong conflict resolution skills and the ability to remain professional during difficult interactions with customers.

Salary Range:

$43,300 - $57,960

​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

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.