Provider Strategy Coordinator at Horizon Blue Cross Blue Shield of New Jersey in Hopewell, New Jersey

Job Description:

Job Summary:

This position is responsible for implementing various initiatives that cross department lines in support of HCM's strategic goals and will interface with all levels of management to ensure that all objectives are met and initiatives are implemented. This position is also responsible for ensuring compliance with accrediting, state and federal guidelines as well as divisional compliance.

Responsibilities:

* Research, coordinate and oversee development and implementation of special projects, studies and reports to satisfy information demands of management or various accreditation and regulatory requirements.

* Ensure network compliance and consistency by identifying and correcting deficiencies relating to network compliance and/or network consistency.

* Support and implement accreditation, regulatory and compliance activities, i.e. NCQA, URAC, CMS, physician contracts, site visit activities, etc.

* Develop, implement and drive Action Plans to improve CAHPS and HEDIS scores.

* Develop, implement and monitor policies, procedures, workflows and process improvements related to the department.

* Interface with Market Business Units on new product implementations and projects; i.e., Product Rationalization and Health Care Reform.

* Develop, coordinate and disseminate physician communications.

* Develop and coordinate education documents for internal and external audiences.

* Represents department at workgroup meetings and facilitates cross-functional teams to implement various network initiatives.

* Facilitates cross-functional teams to implement various network initiatives.

* Create and develop materials for seminars; this includes interacting with leadership of other divisions and contracting and negotiating with outside organizations and vendors.

* Develop and drive Action Plans to improve Office Manager satisfaction scores.

* Develop responses to RFIs and RFPs regarding Horizon's physician network, contracting standards and processes and ensure timely and accurate responses to the Proposal Department.

Knowledge:

* Requires solid understanding of managed care principles, including capitation and PPOs.

* Requires knowledge of healthcare industry.

* Prefers knowledge of provider contracting

* Prefers knowledge of State and Federal healthcare regulations

* Prefers knowledge of major competitors

Skills and Abilities:

* Requires excellent written and verbal communication skills and excellent presentation skills.

* Requires the ability to work independently, set priorities and manage time effectively.

* Requires extensive PC skills, preferably with Microsoft Access, Lotus Notes, Microsoft Word and Excel or comparable software.

* Requires analytical skills necessary to evaluate trends, make recommendations and explain data.

* Requires problem-solving skills necessary to identify and resolve member or provider complaints or concerns.

* Prefers negotiation skills.

Education:

* Require a Bachelor's degree from an accredited college or university with a major in business healthcare administration, finance, marketing or communications or comparable business experience.

Experience:

* Requires 3-5 years' experience in provider relations.

* Strongly prefer experience in supporting and implementing accreditation, regulatory and compliance activities, i.e. NCQA, URAC, CMS, physician contracts, site visit activities, etc.

* Prior sales or marketing experience preferred.

Travel (If Applicable):

* Yes

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

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. Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.

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