Network Contracting Account Specialist

Job Description:

• Facilitate and lead negotiations with hospital, physician, and ancillary network providers
• Prepare contract rate proposals with Medical Economics, Actuary, Payment Model Evolution, and Provider Experience teams
• Support fee-for-service and value-based payment contracting initiatives across Horizon lines of business
• Facilitate execution and maintenance of network contracting strategy and policies
• Implement contracts and special arrangements accurately across systems
• Manage provider file maintenance requests, claims stops, and new hospital implementations
• Review claims, configuration, provider mapping, and system-wide technical inefficiencies
• Research operational deficiencies, identify root causes, and analyze fallout reports
• Coordinate hospital, ancillary, and professional rate loads, pricing configurations, DRG updates, and contract storage
• Resolve contract reporting, provider file maintenance, claims stop, and hospital implementation issues with matrix partners
• Analyze contracts to identify medical cost savings and implement industry initiatives
• Maintain provider contract language and templates and ensure contracts can be configured into core systems
• Collaborate with Legal and Compliance on contract templates and regulatory requirements
• Develop and implement provider contracting policies and procedures
• Contribute to value-based contracting strategy and enterprise affordability objectives
• Collaborate across departments to align provider services with member and organizational needs
• Create materials for industry conferences, webinars, and other events

Requirements:

• High School Diploma/GED required
• Bachelor degree in business, finance, accounting, health administration preferred or relevant experience in lieu of degree
• Preferred Master’s degree in health or business
• Minimum of 5 years of business experience in hospital finance and/or managed care network development
• Minimum 5 years demonstrated experience in two or more with in-depth knowledge and understanding of contract finance and reimbursement methodologies including FFS, Medicare DRG and APC’s, Medicaid pricing, capitation, full risk, shared savings and incentive arrangements
• Minimum of 5 years provider experience in Commercial, Medicare, Medicaid, and Value Based Programs
• Minimum of 5 years’ experience in health care cost data analysis and technical document writing
• Proficiency in personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint)
• Knowledge of intranet and internet applications
• Knowledge of Principles of Health Care contracting
• Knowledge of the health care or health insurance industry
• Knowledge of hospital and physician communities in New Jersey
• Knowledge of insurance, HMO, hospital and physician practice laws and regulations
• Knowledge of quality measurement approaches applied in insurance, HMO, hospital and physician practice
• Ability to create, develop, and maintain business relationships
• Analytical, business case and product design skills
• Ability to exercise sound judgment, ask probing questions, and obtain thorough and relevant information
• Detail-oriented with strong organizational, problem-solving, organizational, and instruction-following skills
• Ability to adapt to multiple responsibilities across multiple organizational areas
• Ability to present information and respond to questions from groups of managers, clients, and customers
• Effective verbal and written communication skills and ability to work well within a team
• Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware

Benefits:

• Comprehensive health benefits (Medical/Dental/Vision)
• Retirement Plans
• Generous PTO
• Incentive Plans
• Wellness Programs
• Paid Volunteer Time Off
• Tuition Reimbursement
• Moderate travel is required