Medical Policy Analyst – Part-Time, 32 hrs weekly

Job not on LinkedIn

🔥 0 minutes ago

🦌 Connecticut, New Jersey, +2 more states – Remote

🦌 Connecticut – Remote 🏖️ New Jersey – Remote 🗽 New York – Remote 🔔 Pennsylvania – Remote

💵 $70.5k - $94.4k / year

⏱ Part Time

🟡 Mid-level

🟠 Senior

🧐 Analyst

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Horizon Connect @ Wall BCBSNJ

WebsiteLinkedInAll Job Openings

2 - 10 employees

⚕️ Healthcare Insurance

🏥 Healthcare

Healthcare Insurance • Healthcare

Horizon Connect @ Wall BCBSNJ is a LinkedIn presence or local program/office associated with Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ). Based on the name and context, it appears to be connected to Horizon BCBSNJ’s health insurance operations and local outreach or member/provider engagement in the Wall, NJ area. Publicly available information provided is limited and mostly LinkedIn site chrome rather than a company profile, so this description is conservative and based on the affiliation indicated by the name.

📋 Description

• Perform reviews of post-service medical necessity and appealed claims for compliance with medical policy, plan benefits, and provider coding • Prepare cases for Medical Director and/or outside consultant review and response where appropriate • Provide timely and accurate responses to inquiries and collaborate with claim policy teams regarding claims pending medical review and appeal inquiries • Communicate opportunities for development or revision of Horizon Medical Policies based on case review outcomes • Manage assigned inventory, document production, and follow assignments through completion • Stay abreast of mandates, policy, and workflow changes impacting the review process and outcomes • Apply knowledge of laws, regulations, and organizational policies to job accountabilities

🎯 Requirements

• High School Diploma/GED required • Minimum of 3 years’ clinical nursing experience • Effective verbal and written communication skills • Ability to work well within a team • Professional and ethical business practices • Adherence to company standards • Commitment to personal and professional development • Proven time management skills • Ability to manage multiple priorities or tasks • Ability to deliver timely and accurate work products with a customer service focus • Ability to respond with a sense of urgency as required • Ability to work in a production-focused environment • Sound judgment and strong problem-solving skills • Ability to ask probing questions and obtain thorough and relevant information • Employees must live in New Jersey, New York, Pennsylvania, Connecticut, or Delaware

🏖️ Benefits

• Comprehensive health benefits (Medical/Dental/Vision) • Retirement Plans • Generous PTO • Incentive Plans • Wellness Programs • Paid Volunteer Time Off • Tuition Reimbursement • Mission-driven organization that values expertise, collaboration, and growth • Reasonable accommodation requests supported during recruiting and hiring