Mgr, Provider Experience & Acct Mgmt

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

Job Summary:

This manager will support the Provider Account Executive with fostering collaborative, trusting provider relationships to drive improved provider satisfaction and network performance. This role will oversee a team of resources consisting of Provider Account Specialists.
This position will manage a team who will help with the triaging and intake of provider questions and issues; onboarding, training and education of providers; review of performance data with provider groups; and overall provider account management activities. This position will collaborate extensively across the Horizon enterprise with other departments and leaders who are responsible for various aspects of network provider interactions and support functions.Responsibilities:

• Manage and assist with a diverse set of provider relationships with exceptional customer service that ensures satisfaction and provider retention.

• Create, build, and maintain positive, trusting, and productive relationships with internal Horizon team members from multiple departments.

• Drive successful provider relationships for all providers and payment arrangements drive as well as successful implementation of our innovative provider agreements, which are new models of reimbursement and care delivery.

• Manage team of Provider Account Specialists; coach and mentor for successful provider relationships and account management.

• Lead meetings to review and discuss provider concerns and goals with cross-functional Horizon teams and directly with provider partners.

• Collaborate with all internal Horizon teams and maintain a strong understanding of Horizon operations and processes, including contracting, provider data management, credentialing, claims, and service operations.

• Act as business owner of providers’ value-based performance, monitoring cost of care, utilization and quality targets and providing performance feedback to providers. 

• Create operating models between key provider partners and Horizon that focus on shared goals and KPIs.

• Collaborate with providers to create population health management action plans, deliverables and milestones; track and monitor workplans for success, working with the providers to course correct as appropriate.

• Collaborate with network contracting team and payment model evolution team to create provider-specific contract proposals for comprehensive reimbursement strategy that aligns with Horizon’s goals. 

• Answers or triages provider questions, issues, and concerns when applicable.

• Assists with the day-to-day operations of the team.

• Engage team in critical provider concerns.

• Engage Horizon partners in critical network activities including demographic updates, re-credentialing, contract renewals, and ongoing network training and education.

• Provide strategic direction on contract renewals and alternative payment model performance management.

• Oversee provider onboarding and orientation.

• Resolve provider inquiries.

• Coordinate with other Horizon stakeholders.

• Introduce providers to new payment models and assess eligibility for value-based programs.

• Manage, develop and train staff; develop and monitor goals; conduct annual performance reviews, and administer salaries for the staff.

• Effectively communicate key provider issues and performance to key stakeholders including Directors and VPs.

• Administer and review provider satisfaction surveys; implement actions to improve survey results.

Disclaimer:

This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job.

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 healthcare experience.

• Requires a minimum of 5 years experience in successfully leading cross-functional teams to achieve improvements or relevant experience in lieu of 5 years experience. 

• Requires a minimum of 3 years demonstrated proficient experience working with and interpreting data to develop strategies, insights and guidance cross-functionally.

• Requires a minimum of 3 years of experience trouble shooting complex service inquiries.

• Requires direct or indirect provider experience.

• Prefers project leadership/management experience.

• Requires a minimum of 3 years supervisory experience and/or leading people by influence. 

Skills / Abilities:

• Demonstrates ability to create, develop, and maintain business relationships in the Provider space.

• 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.

Knowledge :

• Must be proficient in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint) and Lotus Notes; 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.

Salary Range:

$106,400 - $145,215

​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.