[Hiring] Medicare Auditor I @Horizon Blue Cross Blue Shield of New Jersey

Role Description

Responsible for determining primacy between Medicare and Horizon, identifying overpayments and processing Medicare Demands received from the Medicare Secondary Payer Recovery Contractor or the Department of U.S. Treasury.

What You'll Do

• Review and verify data integrity of Medicare files.
• Determine primacy and coordinate system updates as needed.
• Review End-Stage Renal Disease cases and determine Medicare primacy.
• Review recovery opportunities identified by vendors and determine whether identified recoveries are valid.
• Respond to Medicare-related questions from Account Managers, brokers, groups, members, and other customers.
• Support MSP inventory reporting, MRM hierarchy-error review, and Claimstop/PLOG review.
• Using information such as Medicare data, group size, and working status to determine whether Horizon or Medicare is primary.
• Process claims to repay Medicare or the Treasury Department following CMS Regulations.
• Update tracking system accordingly.
• Ability to research and apply benefits as needed.
• Ability to read and understand New Membership System (NMS) and Nasco.
• Perform other related tasks as assigned by management.

Qualifications

• High School Diploma/GED required.
• Minimum of 2 years experience in processing and adjusting claims.

Requirements

• Knowledge of Medicare.
• Knowledge of Medicare Secondary Payer regulations.
• Knowledge of NMS and Nasco.
• Knowledge of Sales internal systems NAEGS and CPL.
• Strong Computer Skills.
• Multitasking, strong Interpersonal skills, critical thinking, organizational skills and strong Written and Verbal Skills.
• Proficiency in Microsoft Excel, Microsoft Access, and Microsoft Word.
• Familiarity with systems such as Nasco, NCompass, NMS, FileNet, and Cirrus.

Benefits

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

Salary Range

$50,100 - $67,095