Value-Based Network Contracting Specialist

100 Horizon Healthcare Services, Inc; Hopewell (NJ); On-site; USD 87,300 - 119,070; Full time

Benefits offered by this job

Comprehensive health benefits

Retirement Plans

Generous PTO

Incentive Plans

Wellness Programs

Paid Volunteer Time Off

Tuition Reimbursement

Job summary

Horizon Blue Cross Blue Shield of New Jersey is seeking a role that will lead network provider negotiations across commercial, Medicare, Medicaid, DSNP, MLTSS and Casualty services. The position drives contract accuracy, rate proposals, and policy development while ensuring regulatory compliance and alignment with enterprise affordability.

The role requires 5+ years in hospital finance or managed care network development, with strong negotiation, analytical, and collaboration skills to engage

Qualifications

• Bachelor degree in business, finance, accounting, health administration preferred or relevant experience in lieu of degree.
• Master’s degree in health or business preferred.
• Minimum 5 years of business experience in hospital finance and/or managed care network development.
• Minimum 5 years provider experience in Commercial, Medicare, Medicaid, and Value Based Programs.
• Minimum 5 years’ experience in hospital finance and/or managed care network development.

Responsibilities

• Facilitate and lead network provider negotiations for Horizons medical lines of business (Commercial, Medicare, Medicaid, DSNP, MLTSS, Casualty).
• Ensure accurate implementation of contracts; coordinate with other departments on loading contracts and special arrangements.
• Initiate and manage provider file maintenance requests, claims stops, and new hospital implementations.
• Review system-wide claims, configuration, and provider mapping discrepancies for technical efficiency.
• Collaborate with internal partners to research root causes and generate fall-out reports for operational deficiencies.
• Prepare rate proposals for all lines of business with Medical Economics and Actuary.
• Ensure timely contract submission and loading; interface with matrix partners.
• Coordinate network implementation across hospital, ancillary, and professional rate loads and DRG updates.
• Provide contract language templates and ensure configuration in core systems.
• Develop and enforce provider contracting policies aligned with regulatory requirements.
• Collaborate across departments to align provider services with member needs.
• Support industry events with material for conferences and webinars.
• Develop and implement provider contracting policies and procedures per industry best practices.
• Collaborate to ensure provider network supports enterprise affordability objectives.

Skills

Negotiation skills

Financial analysis

Regulatory knowledge

Communication skills

Team collaboration

Attention to detail

Education

Bachelor degree in business/finance/health

Master’s in health or business (preferred)

High School Diploma/GED (required)

Tools

MS Excel

MS Office

Job description

Horizon Blue Cross Blue Shield of New Jersey is seeking a role that will lead network provider negotiations across commercial, Medicare, Medicaid, DSNP, MLTSS and Casualty services. The position drives contract accuracy, rate proposals, and policy development while ensuring regulatory compliance and alignment with enterprise affordability.

The role requires 5+ years in hospital finance or managed care network development, with strong negotiation, analytical, and collaboration skills to engage