Strategic Network Contracts Specialist

100 Horizon Healthcare Services, Inc; Newark (NJ); Presencial; USD 87.000 - 119.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Comprehensive health benefits

Retirement Plans

Generous PTO

Incentive Plans

Wellness Programs

Paid Volunteer Time Off

Tuition Reimbursement

Descripción de la vacante

Horizon Blue Cross Blue Shield of New Jersey is seeking an experienced professional to lead network provider negotiations across Commercial, Medicare, Medicaid, DSNP, MLTSS, and Casualty lines.

You will ensure contracts are implemented accurately, coordinate with Legal, Compliance, and Medical Economics teams, and drive value-based contracting initiatives while maintaining compliance with regulatory requirements.

Formación

• Minimum 5 years of business experience in hospital finance or managed care network development.
• Minimum 5 years in two or more contract finance and reimbursement methodologies (FFS, DRG, APCs, Medicaid pricing, capitation, full risk, shared savings).
• Experience in Commercial, Medicare, Medicaid, and Value Based Programs.
• Experience with hospital finance and/or managed care network development.

Responsabilidades

• Facilitate and lead network provider negotiations for Horizons medical lines of business.
• Ensure accurate implementation of contracts across departments.
• Initiate and manage provider file maintenance requests and hospital implementations.
• Review system-wide claims, configuration, and provider mapping discrepancies.
• Collaborate with internal partners to conduct root cause analyses and report outcomes.
• Prepare rate proposals for all lines of business with actuarial input.
• Coordinate network implementation and contract loading across departments.
• Analyze contracts to identify cost savings and value-based opportunities.

Conocimientos

Negotiation

Contracting

Data analysis

Healthcare knowledge

Communication

Educación

Bachelor's degree

Master's degree preferred

Herramientas

MS Office

Contract management system

Descripción del empleo

Horizon Blue Cross Blue Shield of New Jersey is seeking an experienced professional to lead network provider negotiations across Commercial, Medicare, Medicaid, DSNP, MLTSS, and Casualty lines.

You will ensure contracts are implemented accurately, coordinate with Legal, Compliance, and Medical Economics teams, and drive value-based contracting initiatives while maintaining compliance with regulatory requirements.