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.

• Requires the ability to manage and motivate other.

• Proficiency in Excel strongly preferred

Travel:

• Travel primarily within State of NJ may be required. Occasional travel in the tri-state area may also be required.

Salary Range:

$86,000 - $117,390

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

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.

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.