Posted in Other 30+ days ago.
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Type: Full Time
Location: EWING, New Jersey
Responsible for producing reports from various sources to provide the department /division with actionable information or business intelligence. Working with marginal oversight, the incumbent is responsible for performing complex research, analysis, and reporting of network utilization, cost containment and key operational information. This is a senior level position.
* Evaluate data and report findings for accuracy, completeness, intent, and scope, etc.
* Determine or agree upon deliverables with customer, as well as determining the resources necessary to meet those deliverables
* Act as liaison with IT /vendor and customer and initiate /implement project plan for requests
* Perform appropriate analysis on data: forecasting, modeling, regression
* Mine data from appropriate system and perform appropriate analysis on data
* Present data and provide feedback to client/customer; making recommendations where appropriate
* Provides guidance and day-to-day oversight of reconciliation functions to support Monthly Membership Reports, Medicare Secondary Payer and Coordination of Benefits
* Challenge the status quo and propose improvements in processes for higher efficiency and effectiveness
* Accountable for the financial reconciliation and vendor reconciliations for assigned lines of business
* Establish, monitor, and enforce reconciliation policies and procedures and internal controls
* Accountable for researching existing and new legislative changes in federal and statutory requirements
* Develop relationships with subject matter experts (SME)
* Seek and adopt best practices in data reporting
* Perform other relevant tasks as assigned by management
* Bachelor degree or equivalent years of work experience is required
* Minimum of five (5) years of business operations or similar experience is required, preferably in a health care environment
* Prefer five (5) years data reporting experience
* Strong PC skills
* Understanding interdependencies among data
* Prefers SAS/SQL knowledge
Travel (If Applicable):
* Some travel may be required.
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.