Provider Data Management Analyst II

Horizon Blue Cross Blue Shield of New Jersey; Oregon; Hybrid; USD 63,000 - 84,000; Full time

Benefits offered by this job

Health benefits

Retirement plans

Generous PTO

Incentive plans

Wellness programs

Paid Volunteer Time Off

Tuition reimbursement

Job summary

Horizon Blue Cross Blue Shield of New Jersey is seeking a Provider Data Management professional to support Government Programs provider data, screen loading, and coordinate procedures across systems. This role requires attention to detail and the ability to manage sensitive projects.

You will work with cross-functional teams to maintain accurate provider files, resolve data errors, and contribute to quality reporting and vendor audits.

Qualifications

• High School Diploma/GED required.
• Minimum of 5 years relevant work experience in provider data management in Healthcare/insurance is required.
• Knowledge of healthcare provider systems and claims processing systems.
• Understanding of managed care and indemnity business models and operations.
• Familiarity with provider credentialing processes, provider data integration, system enhancement projects, and testing methodologies.
• Knowledge of medical terminology and healthcare procedures.
• Experience supporting vendor audits, compliance activities, or operational reporting.
• Use of AI tools to support operational efficiency.

Responsibilities

• Assist with the direction and supervision activities of the Provider File Area to ensure the accurate, complete and timely maintenance of the Government Programs provider data files.
• Resolve provider data errors by identifying causation and recommend improvements, identifying strengths and documenting best practices. Investigates all incidents impacting the data integrity and programs to allow for analysis of trends and potential vulnerability.
• Assist in the preparation, development and analysis of specifications for system enhancements and modifications to ensure provider files integrate properly with current and planned systems.
• Produces and develops specifications and user testing criteria while securing appropriate documentation to assure accurate data in file.
• Evaluate and recommend improvements to specific current operating procedures to enhance operating efficiencies and controls.
• Handle important or sensitive projects and priorities that require a high degree of attention.
• Produce departmental reporting for quality and production, including vendor audits.
• Provide departmental representation on workgroups and committees.

Skills

Attention to detail

Analytical abilities

Oral and written communication

Education

High School Diploma/GED

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking a Provider Data Management professional to support Government Programs provider data, screen loading, and coordinate procedures across systems. This role requires attention to detail and the ability to manage sensitive projects.

You will work with cross-functional teams to maintain accurate provider files, resolve data errors, and contribute to quality reporting and vendor audits.