Medicare Auditor I

Job not on LinkedIn

🔥 13 minutes ago

🏖️ New Jersey – Remote

🏖️ New Jersey – Remote

💵 $50.1k - $67.1k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

🔎 Auditor

🚫👨‍🎓 No degree required

👻 Ghost score 14%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.Why this score:

• Just posted.
• Jobs at this company usually fill in 21 days.

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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

• 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 • Use 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 • Research and apply benefits as needed • Read and understand New Membership System (NMS) and Nasco • Perform other related tasks as assigned by management

🎯 Requirements

• High School Diploma/GED required • Minimum of 2 years experience in processing and adjusting claims • 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 • Microsoft Excel • Microsoft Access • Microsoft Word • Experience with Nasco, NCompass, NMS, FileNet, and Cirrus systems

🏖️ Benefits

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

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