[Hiring] Contract Pricing Configuration Analyst @Horizon Blue Cross Blue Shield of New Jersey

Role Description

Responsible for the accurate and timely configuration and maintenance of provider reimbursement arrangements for healthcare professionals, institutions, and ancillaries.

Candidate MUST have: Strong analytical skills dealing with hospitals, ancillary, and provider contracts.

What You'll Do

• Interpret company reimbursement arrangements for healthcare professionals, institutions, and ancillaries.
• Consult with relevant contract manager or reimbursement lead to determine appropriate interpretation and configuration of contract terms.
• Unit test simple configuration changes to ensure accuracy of rate load.
• Respond to internal and external provider fee requests.
• Perform problem resolution of configuration issues identified by the Service division or Provider Relations area.
• Monitor and test the accuracy of price rules, fee schedules, contract loads as assigned.
• Assist with audit function to support both internal and external audits required by the company (SOX, SSAE16).
• Assist the Leads in the implementation of enterprise initiatives impacting pricing.
• Understand medical terminology, medical coding (CPT4, ICD9/ICD10, and HCPCS), provider contract concepts, and common claims processing/resolution practices.

Qualifications

• High School Diploma/GED required.
• Requires 3-5 years of Health Care experience specifically in provider contract and pricing configuration.
• In lieu of degree, requires 5 years of Health Care experience, specifically in provider contract and pricing configuration.
• Requires prior experience in one or more claim systems.
• Requires experience with pricing and/or provider contract arrangements.
• Prefers experience with NetworX Pricer and NetworX PBA.
• Prefers knowledge of one or more claim systems with preference in claims processing, pricing, and contract setup.

Requirements

• Prefers knowledge of business and technical requirements.
• Prefer Claims processing systems knowledge.
• Prefer knowledge of testing life cycle.
• Working knowledge of MS tools, including MS Office products, MS Access, SQL Server.

Skills and Abilities

• Excellent communication and presentation skills (verbal and written) since this is a direct business-facing role.
• Must be client service focused with effective ability to empathize.
• Needs to demonstrate willingness to cross-train, and be cross-trained, in other roles/duties.
• Must be detail-oriented with strong organizational and data processing skills.
• Proven ability to follow detailed instructions is essential, along with proven problem-solving skills.
• Proven analytical, research, and problem-solving skills a must.
• Must demonstrate the ability to learn quickly and apply learning to new situations.
• Must exhibit flexibility to change as appropriate.
• Exhibits an energetic, inquisitive, positive approach to problem-solving.
• Ability to maintain attendance to support required quality and quantity of work.
• Multi-tasking skills and planning for prioritizing workload.

Benefits

• Comprehensive health benefits (Medical/Dental/Vision).
• Retirement Plans.
• Generous PTO.
• Incentive Plans.
• Wellness Programs.
• Paid Volunteer Time Off.
• Tuition Reimbursement.