Medical Utilization Analyst Job in Newark, New Jersey US
Job Summary
This position is accountable for the detection, investigation, resolution and prevention of utilization abuse and mismanagement of BCBS benefits by providers and subscribers. Assists in the development and implementation of all projects and programs, which support the Plan's Cost Containment efforts.
Job Qualifications
Education/Experience:
1. Requires a Bachelor's degree.
2. Requires a Registered Nurse (RN) license.
3. Requires a minimum of two years clinical experience.
4. Requires a minimum of one year business/insurance experience with Utilization Review or medical chart auditing or billing functions, or 6 months claims processing/operations experience
Additional licensing, certifications, registrations:
Requires a NJ Registered Nurse License
Must have a valid drivers license and access to a car
Knowledge:
- Requires knowledge of anatomy, physiology and medical terminology of medical procedures and terminology.
- Requires knowledge of medical/hospital chart format.
- Requires knowledge of medical/hospital chart format.
- Requires knowledge of the health care delivery system.
Skills and Abilities:
- Requires the ability to utilize a personal computer and applicable software.
- Strong negotiation skills with the demonstrated sales ability to convert prospect to client in addition to demonstrated persuasive skills with carriers
- Must have effective verbal and written communication skills and demonstrate the ability to work well within a team. Demonstrated ability to deliver highly technical information to less technical individuals.
- Must demonstrate professional and ethical business practices, adherence to company standards, and a commitment to personal and professional development.
- Proven time management skills are necessary. Must demonstrate the ability to manage multiple priorities [or tasks], deliver timely and accurate work products with a customer service focus, and respond with a sense of urgency as required. Demonstrated ability to work in a production focused environment.
- Proven ability to exercise sound judgment and strong problem solving skills.
- Proven ability to ask probing questions and obtain thorough and relevant information.
- Must be client service focused with effective ability to empathize.
Travel (If Applicable):
Must be willing to travel to various Physicians offices in NJ, PA NY