Utilization Review Coordinator

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

Job Summary:

This position supports the Utilization Management and Network Oversite teams by acting as a liaison between Hospital personnel, Clients and Operational Business members.

• Enters referrals and precertification for Inpatient Utilization Management received from HCS clients into HCS Trak application.
• Updates claim on a daily basis. 
• Contacts hospital billing office with client billing information and closes the claim upon discharge from the hospital upon closure of claim.
• Contacts Hospital UR department to verify admission date and notifies HCS RN of new admission.
• Requests and collects clinical information related to hospital admission.
• Requests discharge plans from Case manager or social worker at hospital to forward to HCS RN.
• Follows up with hospital contacts as necessary until required information is received.
• Communicates with HCS client to verify admission date and the request for clinical information.
• Provides clinical information received from the hospital to the HCS client and has the information saved to the HCS Trak application.
• Maintains various business spreadsheets to track information critical to the teams being supported.
• Receives medical bills for pricing from HCS clients, creates claim in HCS Trak application and initiates the medical bill pricing process.
• Handles additional team support activities as assigned by management.

Education/Experience

• Requires High School Diploma, some college preferred.
• Requires a minimum of 2 years of experience in customer services or medical support related position.

Knowledge:

• Requires knowledge of medical terminology.
• Prefer knowledge of Utilization Review
• Prefer knowledge of ability to analyze and resolve problems with minimal supervision

Skills and Abilities

• Requires strong organization skills.
• Requires strong oral and written communication skills.
• Manage team inbox email and calibration with team members and other departments.
• Requires STRONG PC skills and the ability to utilize Microsoft Office Applications (Excel, Word, Teams, etc.)
• Team Player, Strong Analytical, Interpersonal Skills

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.