[Hiring] Provider Strategy Coordinator @Horizon Blue Cross Blue Shield of New Jersey

Role Description

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.

What You'll Do

• 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.
• Represent department at workgroup meetings and facilitate 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.

Qualifications

• Bachelor's degree from an accredited college or university with a major in business healthcare administration, finance, marketing or communications or comparable business experience.
• 3-5 years experience in provider relations.
• Prior sales or marketing experience preferred.

Requirements

• Solid understanding of managed care principles, including capitation and PPOs.
• Knowledge of healthcare industry.
• Prefer knowledge of provider contracting.
• Prefer knowledge of State and Federal healthcare regulations.
• Prefer knowledge of major competitors.
• Excellent written and verbal communication skills and excellent presentation skills.
• Ability to work independently, set priorities and manage time effectively.
• Extensive PC skills, preferably with Microsoft Access, Lotus Notes, Microsoft Word and Excel or comparable software.
• Analytical skills necessary to evaluate trends, make recommendations and explain data.
• Problem-solving skills necessary to identify and resolve member or provider complaints or concerns.
• Negotiation skills preferred.

Benefits

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

Salary Range

$79,100 - $105,945