Remote Appeals Resolution Specialist

Horizon Blue Cross Blue Shield; Northern (KY); Hybrid; USD 45,000 - 60,000; Full time

Job summary

Horizon Blue Cross Blue Shield of New Jersey is seeking an Appeals Resolution Analyst to support government program appeals from Hopewell, NJ, with remote work options. You will manage end-to-end appeals, including data entry, external review coordination, and timely case closure, under supervision.

The role requires strong communication and analytical skills, knowledge of CPT-4 and ICD-9, and familiarity with medical terminology.

Qualifications

• Requires high school diploma; bachelor's degree preferred.
• Prefer a minimum of one year acute care medical-surgical or rehabilitation experience.
• Knowledge of CPT-4 and ICD-9 coding; medical terminology is required.

Responsibilities

• Process end-to-end appeals, including receipt, data entry, external review coordination, and timely case completion.
• Speak to providers and members regarding the appeal process and status of appeals.
• Triage the appeal Hotline phone queue and provide timely updates.
• Collaborate with internal and external vendors to ensure regulatory standards (NCQA/DOBI) are met.
• Update authorizations based on appeal outcomes and ensure timely claims.

Skills

Communication skills

Analytical thinking

Medical terminology

Data entry

Education

High School diploma or GED

Bachelor's degree preferred

Tools

Medical management system

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking an Appeals Resolution Analyst to support government program appeals from Hopewell, NJ, with remote work options. You will manage end-to-end appeals, including data entry, external review coordination, and timely case closure, under supervision.

The role requires strong communication and analytical skills, knowledge of CPT-4 and ICD-9, and familiarity with medical terminology.