Vendor Services Consultant at Horizon Blue Cross Blue Shield of New Jersey in Hopewell, New Jersey

Job Description:

Job Summary:

This position is responsible for managing the contractual role between the enterprise and its vendors and subcontractors. Accountabilities will include coordinating, monitoring and documenting operational issues associated with the business relationship.

Responsibilities:

• Acts as the liaison between the enterprise, Horizon Internal Audit, as well as subcontractors, vendors, and 3rd party audit agency (NCQA, Group Audit CMS). As needed, addresses day to day operational issues. Works with vendor and subcontractor to accomplish necessary system changes.


• Responsible for education, implementation and monitoring of subcontractors and vendors for service delivery and adherence to Horizon business requirements.


• Participates in new vendor implementations (including expansion of existing relationships) by recommending contract content, conducting a pre-delegation audit, and go-live readiness.


• Facilitates interactions between all subcontractors and vendors to resolve problems and issues regarding compliance and contractual obligations.


• Assists with contract negotiation, analyzes contractual requirements, identifies contract deficiencies and recommend changes. Reports results to applicable committees within the organization.


• Assists with the implementation of new programs and company initiatives, which includes coordinating, documenting and communicating information as appropriate.


• Identifies and implements process improvements targeted to decrease administrative costs and increase work efficiencies related to information technology systems.


• Calculates and assesses financial penalties based on contractual performance.


• Requests and evaluates Corrective Action Plans for adequacy, works with vendor on required changes, communicates approval of Corrective Action Plans to the vendors, and monitors open Corrective Action Plans.


• Coordinates and conducts vendor audits, develops audit reports, presents findings to the appropriate committees within Horizon, and actively monitors all required actions.

ADDENDUM FOR SERVICE DIVISION ROLES:

• Works with vendor and Horizon IT Team to accomplish necessary system changes, supports system access approvals, audits, issue resolution to include Evening and Weekend Support, Testing, Troubleshooting


• Creates, Monitors, Reports financials to include invoice processing, accruals, productivity and projections

The information above is intended to describe the general nature of the work being performed by each incumbent assigned to this position. This job description is not designed to be an exhaustive list of all responsibilities, duties, and skills required of each incumbent.

Education/Experience:

• Requires Bachelors degree from an accredited college or university, preferably in business administration. In lieu of degree, requires a minimum of seven (7) years experience in an operations role.


• Requires a minimum of 3 years of experience in the healthcare industry preferably in compliance and/or auditing.


• Requires prior project management experience.


• Requires experience with action plan development and monitoring.

Additional licensing, certifications, registrations:

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

Knowledge:

• Requires familiarity with contracting concepts.


• Requires knowledge of the regulatory environment state specific laws, mandates and regulations.


• Requires knowledge of managed care and health insurance industry


• Prefers knowledge of the enterprise operations and products.

Skills and Abilities:

• Must be proficient in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint) and Outlook; should be knowledgeable in the use of intranet and internet applications.


• 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.


• Must be detail oriented with strong organizational and data processing skills. Proven ability to follow detailed instructions is essential, along with excellent math skills.


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


• Must demonstrate the ability to learn quickly and apply learning to new situations. Must exhibit flexibility to change as appropriate.


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


• Demonstrated ability to make decisions with little need for direction and to function effectively as a team-oriented, self-starter working across cross-functional lines.


• Must have strong entrepreneurial business development, negotiation, relationship building, and networking skills.

Travel:

• Requires up to 20% of domestic or international travel.

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.

Apply Now