This position is responsible for developing and managing the contracting arrangements between Horizon Healthcare of New Jersey and the participating ancillary networks to enhance Horizon's capabilities for delivery of quality service at an efficient price. This position will negotiate, implement and maintain oversight over ancillary contracted arrangements as well as manage a contracting staff. This position will also assist the Director of Ancillary and Physician Contracting.
Manages, develops and motivates staff responsible for the ancillary contracts.
Develops RFPs with appropriate requirements in order to select ancillary providers for contracting arrangements for the delivery of specialty services.
Analyzes potential contracting arrangements with ancillary providers and negotiates rates to ensure quality service arrangements at an efficient price.
Develops contract arrangements ensuring all requirements are detailed in contract language and implemented in a timely fashion.
Maintains oversight of contracted arrangements ensuring that reporting and quality standards are met and are in compliance with state laws and regulations and new legislation i.e. HIPPA.
Renews existing contracts using analysis of cost and utilization data and service/quality reports to ensure quality care and services at efficient prices.
Trains subordinates on negotiating skills and contract development management.
Monitors performance relative to performance guarantees, delegate oversight policies and contractual compliance and obligations.
Initiates and oversees internal activities relative to provider re-contracting, reeducation, and corrective action plans necessary as a result of information received.
Performs ongoing analysis and assessment of data received from specialty networks and development and coordination of the recommended action plans.
Coordinates activities with operations where appropriate and outside vendors as necessary and monitors new network growth.
Coordinates the development of training programs and materials to ensure appropriate education and management development of provider network groups and internal personnel.
Works closely with Medical Leadership, Utilization Management, Provider Affairs team and network providers to facilitate dialogue pertaining to physician practice patterns and cost effective healthcare delivery.
Develops strategies to minimize network leakage and supervises staff responsible for recruitment, and participates in designing/implementing creative network and reimbursement strategies including risk-sharing arrangements, to support effective cost, quality and marketing objectives.
Assesses competitive position of Horizon's reimbursement rates relative to key competitors and designs/implements strategies that support Horizon’s ability to effectively compete in the marketplace.
.Accountable for maintaining effective internal controls over the processes and transactions under areas of responsibility including the completeness and accuracy of financial information and transactions, compliance with applicable laws and regulations, and the effectiveness and efficiency of operations.
S upervisory Accountability Statement:
Maintains a motivated and productive staff by providing sound leadership and direction; models appropriate behavior; renders timely decisions; provides coaching, feedback and recognition; conducts appropriate and timely performance appraisals; selects the best qualified candidates to fill job vacancies; administers company policies fairly; provides for development activities and opportunities to assure the application and assessment of skills learned. Measures may include:
Review of PM Plans/Appraisals
Solicited and unsolicited staff feedback
Employee satisfaction results
Report on late Performance Appraisals
As a supervisor, complies with laws, regulations and policies, and takes reasonable steps to assure that staff members know and understand the laws, regulations and policies that pertain to the organizational unit's business and takes reasonable steps to assure that staff members conform their actions accordingly.
Requires a Bachelor's degree in business, finance, accounting, health administration or any other related field from an accredited college.
Requires a minimum five (5) years business experience in hospital finance and/or managed care network development.
Requires experience in health care cost data analysis and technical document writing.
Requires excellent presentation skills.
Prefer supervisory experience.
Requires knowledge of principles of health care contracting.
Requires knowledge of health care industry or health insurance industry.
Requires knowledge of ancillary communities in the States of New Jersey, Pennsylvania, and Delaware
Requires knowledge of personal computers and software applications.
Skills and Abilities:
Requires strong financial skills to support contract negotiations, along with strong negotiation skills.
Requires excellent written and verbal communication skills.
Requires strong analytical skills.
Requires strong negotiating skills.
Requires strong interpersonal, organizational and problem solving skills.
Requires good leadership skills.
Requires good PC skills.
Horizon Blue Cross Blue Shield of New Jersey - 14 months ago