Ancillary Contracting Specialist at Horizon Blue Cross Blue Shield of New Jersey in Newark, New Jersey

Job Description:

Job Summary:

This position is responsible for overseeing contracts between hospitals in the Select Hospital Network or ancillary contracts (i.e. SNF's Sub-acute, Home IV, etc.) and Horizon Blue Cross Blue Shield, and for ensuring that the contractual arrangement is fulfilled. Accountability's may include developing, negotiating and managing the ancillary contracting arrangements. In addition, this position will be responsible for developing and maintaining effective relationships with CFOs, diagnosing organizational capability during implementation of contractual arrangements, and defining the hospital's or ancillary's role in its local community. Develop training programs and materials to ensure appropriate education of hospital or ancillary personnel.

Responsibilities:

• Provides on-going consultation and advice to key hospital or ancillary officials, helps in the generation, evaluation and selection of ideas to address concerns, and assists in the implementation of these ideas.


• Functions as a liaison between the Select Hospital Network or specialty vendors and areas of HBCBSNJ in order to resolve issues, assure quality and monitor the implementation process.


• Develops a working knowledge of the hospitals' or ancillary's strengths, weaknesses, and role within the communities, and makes recommendations relative to the development of negotiation strategies.


• Conducts on-site visits to hospitals in the Select Hospital Network or specialty vendors to ensure continued satisfaction, and coordinates educational seminars on new products, procedures and policies.


• Reviews and monitors data received from vendors or hospitals, and recommends action plans as needed on an ongoing basis.


• Participates in the preparation for and negotiation of new hospital contracts or renews existing vendor contracts using analysis of cost and utilization data and service/quality reports to ensure quality care and service at efficient prices.


• Demonstrates knowledge, understanding and confirms to the laws regulations and policies that pertain to the organizational units business.

Education/Experience:

• Requires a bachelor's degree in finance, economics or accounting or relevant major.


• Requires a minimum of 5 years experience in the health insurance industry or Behavioral Health related experience.

Additional licensing, certifications, registrations:

• Must have a valid driver's license and access to a car.

Knowledge:

• Requires knowledge of various indemnity and managed care products.


• Requires general knowledge of hospital or ancillary reimbursement principles and practices.


• Requires knowledge of Horizon Blue Cross Blue Shield products, Medicaid and Medicare, Department of Health, Federal and State Regulations.

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.


• - Needs to demonstrate willingness to cross-train, and be cross-trained, in other roles/duties.


• - Must be detail oriented with strong organizational and data processing skills. Proven ability to follow detailed instructions is essential, along with proven problem solving skills.


• - Proven analytical, research and problem solving skills a must.


• - Must demonstrate the ability to learn quickly and apply learning to new situations.


• - Proven ability to influence without authority.

Travel:

• Must be willing to travel to various healthcare facilities in NJ, NY or PA.

Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law.

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