Manager Hospital Contracting (must have contract experience working for a Hospital)

Horizon Blue Cross Blue Shield of New Jersey•Hopewell, NJ

16d•$109,600 - $149,625•Onsite

About The Position

Horizon Blue Cross Blue Shield of New Jersey is seeking a Manager Hospital Contracting to lead and support the development, negotiation, management, and maintenance of provider contracts for physician organizations, hospitals, and ancillary facilities. This role involves working with fee-for-service (FFS) and value-based payment contracting initiatives, collaborating with various teams to introduce updated payment models and meet provider expectations. The manager will lead complex negotiations, develop business strategies for financial and legal terms, and work with Medical Economics and Actuary Departments to draft and negotiate provider rate proposals. Responsibilities also include managing regulatory, accreditation, and network adequacy requirements, performing quarterly analyses of the provider network, and evaluating opportunities to expand or modify the network. The role involves managing budgeting and forecasting for product lines related to network costs and provider contracts, and contributing to drafting contract terms that align with regulatory, accreditation, and enterprise requirements. The ideal candidate will have a proven track record in network contracting strategies and negotiating with healthcare providers, and will lead a team of specialists. Excellent communication and leadership skills are essential for working with diverse stakeholders. The team will negotiate and execute contracts for all payment arrangements, maintain contract standards, collaborate with payment strategy and provider experience teams, and recruit out-of-network providers.

Requirements

High School Diploma/GED required.
Requires a minimum of 5 years demonstrated business experience in hospital and provider group finance and/or managed care network development.
Requires a minimum of 5 years in-depth knowledge and understanding of contract finance and reimbursement methodologies including FFS, Medicare DRG and APC’s, Medicaid pricing, capitation, full risk, shared savings and incentive arrangements.
Requires a minimum of 5 years’ experience in successfully leading cross-functional teams to achieve improvements.
Requires a minimum of 5 years prior provider experience in Commercial, Medicare, Medicaid, and Value Based Programs is required.
Requires a minimum of 3 years’ experience in health care cost data analysis and technical document writing.
Requires a minimum of 3 years supervisory experience and/or leading people by influence.
Demonstrates ability to create, develop, and maintain business relationships.
Proven analytical, business case and product design skills a must.
Proven ability to exercise sound judgment.
Proven ability to ask probing questions and obtain thorough and relevant information.
Must be detail oriented with strong organizational skills.
Proven ability to follow detailed instructions is essential, along with proven problem-solving skills.
Demonstrates flexibility and adapts to multiple responsibilities encompassing multiple areas within the organization.
Must demonstrate the ability to effectively present information and respond to questions from groups of managers, clients, customers.
Must have effective verbal and written communication skills and demonstrate the ability to work well within a team.
Must be proficient in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint); Should be knowledgeable in the use of intranet and internet applications.
Requires knowledge of Principals of Health Care contracting.
Requires knowledge of health care industry or health insurance industry.
Requires knowledge of the hospital and physician communities in the state of New Jersey.
Requires knowledge of laws and regulations regulating insurance, HMO hospital and physician practice.
Requires knowledge of quality measurement approaches applied in measuring insurance, HMO, hospital, and physician practice.
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware.

Nice To Haves

Bachelor degree preferred or relevant experience in lieu of degree in health or health care related field from an accredited college or university or relevant experience.

Responsibilities

Manage 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.
Manage and negotiate contracts in compliance with Horizon reimbursement standards, and other key controls.
Assist and implement provider contracting policies and procedures that are consistent with industry best practices and regulatory requirements.
Ensures accurate implementation of contracts in addition to working with other departments to assure contract and special arrangement reporting, provider file maintenance requests, claims stops and new hospital implementation.
Manages the maintenance of all provider contract language and templates and ensures that all negotiated contracts can be configured into the core systems.
Collaborates with Legal and Compliance as needed to modify provider contract templates to ensure compliance with all regulatory, accreditation and enterprise requirements.
Understands the Enterprise Strategic and Financial Plan.
Understands Value Based Programs including the financial, quality and operational aspects.
Responsible for accurate and timely contract loading and submissions and interface with matrix partners for network implementation and maintenance all lines of business.
Manages the effectiveness and efficiencies of operations which includes management of contract inventory and adherence to all regulatory requirements and internal policies and procedures.
Implements multi-million dollar medical cost savings by introducing innovative industry initiatives and programs.
Understand the credentialing and recredentialing process, provider directory maintenance, and regulatory standards.
Collaborate across departments to ensure that provider services are aligned with the needs of members and the organization.
Assist with keeping the provider network integrated with the organization’s objectives.
Provide management level leadership and support all of the contracting staff.
Assist the team with skills, knowledge, and resources needed to effectively manage the provider network and achieve team goals.
Represent the organization at industry conferences, webinars, and other events.
Manage, develop and train staff; develop and monitor goals; conduct annual performance reviews, and administers salaries for the staff.