Physician Contracting Specialist-Behavioral Health

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 position is accountable for contracting of behavioral health (BH) professional agreements including the design, development and maintenance of BH special arrangement contracts in support of overall provider strategy and network development needs. Includes unit-cost modeling, negotiations and implementation associated with newly executed or renewals for professional behavioral health agreements. Responsible for the ongoing financial impact analysis for the BH professional network.

Responsibilities:

• Directly negotiates behavioral health special arrangement contracts and oversees implementation of such agreements.  Coordinates with Director of Network Innovation and Network Executive to maintain budgeting, reporting and reconciliation of any behavioral health pay for performance incentives associated with professional special arrangements to support overall network strategy.   Supports peer physical health contracting specialists with behavioral health aspects of multi-specialty and hospital based physician group special arrangements.

• Evaluates existing special arrangements including utilization trends and performance against service-level agreements.  Formulates recommendations to BH leadership for any adjustments to existing contract terms.

• Evaluates potential special arrangements using unit cost modeling by practitioner specialty, market network composition and/or clinical specialization needs, and presents arrangements to BH leadership for approval.  Prepares and presents all proposals to the providers and manages all aspects of the negotiation.   

• Assures all supporting materials and approvals for special arrangements are appropriately maintained and stored in SharePoint repository.

• Coordinates the review of current and historic behavioral health utilization and costs to assess trends in the BH professional network.  Monitors trends of reimbursement adjustment requests in collaboration with HCM supervisor and network specialists.

• Supports the transition from fee-for-service compensation to value-based care for the BH professional network. 

• Monitors out-of-network spend and develops and executes recruitment strategies to address reduction in overall cost of care and MCAP initiatives.

• Manages BH professional unit cost reporting and coordination with analytics and medical economics team and supports annual budgeting activities for BH professional network.

Education/Experience:

• High School Diploma/GED required.

• Bachelor degree in Accounting/Finance preferred or relevant experience in lieu of degree.

• Prefers CPA.

• Requires a minimum of seven (7) years managed care experience including familiarity with the development and implementation of a variety of risk sharing and provider incentive programs.

• Requires a minimum of five (5) years business experience in contract development and negotiation.

• Behavioral Health experience strongly preferred.

• Provider and hospital contracting experience in the NJ/NY markets strongly preferred.

Knowledge

• Requires in-depth knowledge of the managed care philosophy and principles.

• Requires a broad knowledge of GAAP/STAT financial accounting and finance.

• Requires a thorough understanding of managed care policies and procedures.

• Requires general knowledge of management information systems.

Skills and Abilities:

• Requires excellent presentation, oral and written communication skills.

• Requires strong negotiation skills.

• Requires the ability to think analytically and creatively.

• Requires strong organizational skills.

• Requires strong interpersonal skills.