Network Contracting Account Specialist

Job not on LinkedIn

🔥 12 hours ago

🦌 Connecticut, New Jersey, +2 more states – Remote

🦌 Connecticut – Remote 🏖️ New Jersey – Remote 🗽 New York – Remote 🔔 Pennsylvania – Remote

💵 $87.3k - $119.1k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 13%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Horizon Connect @ Wall BCBSNJ

WebsiteLinkedInAll Job Openings

2 - 10 employees

⚕️ Healthcare Insurance

🏥 Healthcare

Healthcare Insurance • Healthcare

Horizon Connect @ Wall BCBSNJ is a LinkedIn presence or local program/office associated with Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ). Based on the name and context, it appears to be connected to Horizon BCBSNJ’s health insurance operations and local outreach or member/provider engagement in the Wall, NJ area. Publicly available information provided is limited and mostly LinkedIn site chrome rather than a company profile, so this description is conservative and based on the affiliation indicated by the name.

📋 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