Provider Account Specialist

Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health.  For over 90 years, we have been New Jersey’s health solutions leader driving innovations that improve health care quality, affordability, and member experience.  Our members are our neighbors, our friends, and our families.  It is this understanding that drives us to better serve and care for the 3.5 million people who place their trust in us. We pride ourselves on our best-in-class employees and strive to maintain an innovative and inclusive environment that allows them to thrive. When our employees bring their best and succeed, the Company succeeds. 

This Specialist will support the Provider Account Manager with establishing and fostering collaborative, trusting provider relationships to drive improved provider satisfaction and performance. This position will help drive execution of key support deliverables, be a data SME, and ensure project work plans are executed resulting with high-quality deliverables. Responsible for the end-to-end provider experience maintaining effective relationships with all facets of the provider (Hospital, Professional and Ancillary) community, including provider education, facilitation and resolution of complex urgent problems and data integrity maintenance. In addition, where the provider is a value based partner, this position will serve as a key support between Horizon and value based partners through activities related to supporting the integration of the Value-based Partnership, Care Delivery Transformation, Health Affairs, Analytics and other areas, as necessary, to help achieve and advance Horizon’s value based programs and partnership goals. This person will be expected to effectively collaborate within cross-functional teams internally and externally.

This position will manage triage and intake 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:

• Cultivate strong relationships with healthcare providers and payment arrangements by understanding their needs, addressing concerns, and providing support and guidance.

• Deliver exceptional customer service by fostering positive relationships, promoting collaboration and ensuring delivery of high-quality services that ensures both provider and patient satisfaction and retention.

• Create, build, and maintain positive, trusting, productive and mutually beneficial relationships with internal Horizon teams as well as external vendors and partners (for example, Braven Health) with strategic partnerships to support our joint goals.

• Maintain a strong understanding of Horizon operations and processes, including contracting, provider data management, credentialing, claims, and service operations.

• Performs activities that develop prospective relationships with providers by supporting and participating in the recruitment and maintenance of the provider network and improve access and network adequacy.  

• Provides feedback and input in contracting process to improve the services that will maximize the potential for retention and initial provider enrollment.

• Collaborates closely with Medical Leadership and network physicians to facilitate dialogue pertaining to practice patterns and cost effective healthcare delivery by developing expertise in Utilization Management reporting, monitoring reports, and physician quality measures.

• Educates, monitors, analyzes, documents and interacts with physician and other health care professionals to ensure cooperation, understanding, and effective participation in Horizon BCBSNJ products.

• Alerts and escalates to leadership in a timely manner any potential issues and opportunities found through physician interactions.

• Collaborates with Provider Education & Communication team to present seminars, conventions, speeches, etc. to various physician and other health care professionals, billing services, medical societies and internal groups.

• Provides ongoing support and resources to help providers stay updated with industry changes and best practices .Drives communication with pertinent staff and managers to ensure that interdependencies between the departments, other projects and functional work are accurately identified and addressed, and provides status reports to management.

• Triages, researches, addresses, tracks and trends provider questions, issues, and critical concerns when applicable.

• Initiates