Horizon Connect @ Wall BCBSNJ

Analyst

• 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

Medical Policy Analyst – Part-Time, 32 hrs weekly