Network Contractor HCS

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware

Job Summary:

This position will facilitate negotiations on behalf of Horizon Casualty Services (HCS), a NJ DOBI approved Workers’ Compensation Managed Care Organization (WCMCO) and its provider partners of over 6,000 professionals, 500 ancillary and 76 hospitals in our New Jersey, Pennsylvania and New York markets representing $3 Billion in annual provider charges.
The role will collaborate with Clinical Quality, Provider Data Management, Disputes, Health and Network Solutions (HNS) in preparation for contract rate proposals that adhere to HCS’s standard payment methodology, standard contract language, ensure compliance with all worker’s compensation and personal injury protection regulations, accreditation and enterprise requirements while advancing Horizon’s strategic and business objectives.
This role will work directly with the Manager on contracting initiatives for HCS, collaborating with teams across HCS and HNS when appropriate.
The role will facilitate the execution of network contracting strategy and maintenance of contracting policies.

• Facilitate and lead network provider negotiations for HCS Workers’ Compensation and Personal Injury Protection lines of business.
• Accountable for accurate implementation of contracts, including collaborating with other departments to assure contract and special arrangements are loaded correctly.
• Prepares negotiation offers through financial and utilization reporting tools and works with HBCBSNJ Legal Department to secure necessary approvals to ensure all contract offers are compliant with applicable regulations and company policies.
• Coordinates with the team members and other appropriate areas to effectively troubleshoot complex claim situations, contract disputes, executive, VIP, and client referrals.
• Functions as a liaison between the provider network, Horizon Casualty Services, and HBCBSNJ Health Network Solutions to resolve issues, assure quality, and facilitate the implementation process.
• Accountable for the maintenance of all provider contract language and templates and ensures that all negotiated contracts can be configured into the core systems.
• Collaborate with Legal and Compliance as needed to modify provider contract templates to ensure compliance with all regulatory, accreditation and Enterprise requirements.
• Adhere to Horizon standard contract language and payment methodologies.
• Contribute to the development and execution of the network contracting strategy, including methods to adopt value-based contracting for providers operating under fee-for-service models, minimize special arrangements, and align to enterprise affordability objectives.
• Develop and implement provider contracting policies and procedures that are consistent with industry best practices and regulatory requirements.
• Collaborate across departments to ensure that provider services are aligned with the needs of claimants and the organization.
• Screens new provider prospects to determine compliance with business requirements and collects necessary documents and information to allow for clean contract implementation and accurate implementation of provider data into HCS system.
• Responsible for facilitating the professional contract welcome and termination process.
• Develops a working knowledge of the provider or ancillary's strengths, weaknesses, and role within the communities, and makes recommendations relative to the development of negotiation strategies. 
• Develops and maintains relationships with health care organizations/professional associations within assigned territories.
• Responsible for the reporting of initial results and ongoing status updates to management.
• Updates and maintains recruitment reports and databases to provide status updates on negotiation progress in support of internal and external customers.
• Demonstrates knowledge, understanding, and conforms to the laws, regulations, and policies that pertain to the organization and the Workers’ Compensation and Personal Injury Protection lines of business.

Education/Experience

• High School diploma/ GED required.
• Bachelor degree preferred or relevant experience in lieu of degree.
• Requires a minimum of 5 years’ experience in the health insurance and/or casualty industries.
• Requires a minimum of 3+ years’ business experience in contract negotiation in a managed healthcare setting ideally in negotiating various types of contracts, i.e. physician, group, ancillary.

Knowledge

• Prefers knowledge of various Workers’ Compensation and Personal Injury Protection products.
• Requires general knowledge of physicians, healthcare professionals, ancillary and hospital reimbursement principles and practices.
• Prefers knowledge of Department of Banking and Insurance, Federal and State Regulations applicable to the Workers’ Compensation and Personal Injury Protection lines of business and Casualty Insurance.
• Requires strong knowledge of MS Office and related applications.

Skills and Abilities

• Excellent at organizing, managing, and handling competing projects with a proven ability to meet tight deadlines in a fast-paced environment.
• Skilled at managing a high volume of work with changing priorities and frequent interruptions while maintaining the ability to work cooperatively with a positive attitude.
• Excellent written and oral communication skills.
• Facilitation, active listening, and presentation skills.
• Persuasion/negotiation and interpersonal relationship skills and the ability to effectively interact and collaborate with individuals at all levels within the organization; ability to influence without authority.
• Excellent with technology; Microsoft Word, Excel, Power Point, Teams, etc.

Travel (If Applicable)

• Some local travel, within NJ, may be required 10%

Salary Range:

$68,500 - $91,665

​This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This range has been created in good faith based on information known to Horizon at the time of posting. Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes:

• Comprehensive health benefits (Medical/Dental/Vision)

• Retirement Plans

• Generous PTO

• Incentive Plans

• Wellness Programs

• Paid Volunteer Time Off

• Tuition Reimbursement

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.