Sr. Provider Field Claims Coordinator

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware Job Summary: The Sr. Provider Field Claims Coordinator represents the Plan with external and/or internal customers as a subject matter expert and reference point to providing resolution to difficult and complex matters. This position is responsible for claim adjustments, explaining denials and A/R reconciliations and developing process improvements to ensure continuous problems will be corrected. The position will act as a liaison between Network Operations, Ancillary and Provider Services. Responsible for working directly with the Provider Community to resolve outstanding accounts on first contact and determine action steps needed to provide the best service model. Maintains thorough knowledge of all processing systems within service. Review and adjust claims off site and in house as needed. (nasco, qblue, ucsw) Researches, recommends and develops procedural, systemic or other revisions to increase departmental efficiency, accuracy and productivity in service. Coordinates with Network Operations and/or the Provider Community to make field visits to the physicians to provide personalized services in regards to provider education, identifying technical needs and working through benefit/ claim problems. Facilitate and participate in Provider Seminars to ensure coverage of all current claim issues/concerns. Responsible for logging and updating all cases in the Physician Services database. Also responsible for trending and providing analytical reports to Network Operations and/ or the Provider Community. Responds to telephone calls and written inquiries that are received through the Provider Executive Case area. Interfaces with other departments to assure consistent application of policies and procedures. Provide on site support in the Physician-s office two to three times a week on an as needed basis. (co-location) Education/Experience: Bachelor's degree preferred or equivalent work experience Requires a minimum of 3 years experience in direct customer service and/or coordinating services with providers and health care institutions. Specialized knowledge/skills: Must be able to process and adjust claims on Qblue and/or Nasco. Requires working knowledge of UCSW, RCOE, UPS and New Membership. Requires strong analytical and organizational skills. Requires excellent oral and written communication skills. Requires good interpersonal skills and the ability to interface with internal and external customers on a daily basis. TRAVEL within the tri state area approximately three days per week. 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.