Provider Strategy Coordinator

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.
About the Role
This position is responsible for implementing various initiatives that cross department lines in support of HCM's strategic goals and will interface with all levels of management to ensure that all objectives are met and initiatives are implemented. This position is also responsible for ensuring compliance with accrediting, state and federal guidelines as well as divisional compliance. What You'll Do

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Research, coordinate and oversee development and implementation of special projects, studies and reports to satisfy information demands of management or various accreditation and regulatory requirements.

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Ensure network compliance and consistency by identifying and correcting deficiencies relating to network compliance and/or network consistency.

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Support and implement accreditation, regulatory and compliance activities, i.e. NCQA, URAC, CMS, physician contracts, site visit activities, etc.

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Develop, implement and drive Action Plans to improve CAHPS and HEDIS scores.

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Develop, implement and monitor policies, procedures, workflows and process improvements related to the department.

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Interface with Market Business Units on new product implementations and projects; i.e., Product Rationalization and Health Care Reform.

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Develop, coordinate and disseminate physician communications.

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Develop and coordinate education documents for internal and external audiences.

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Represents department at workgroup meetings and facilitates cross-functional teams to implement various network initiatives.

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Facilitates cross-functional teams to implement various network initiatives.

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Create and develop materials for seminars; this includes interacting with leadership of other divisions and contracting and negotiating with outside organizations and vendors.

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Develop and drive Action Plans to improve Office Manager satisfaction scores.

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Develop responses to RFIs and RFPs regarding Horizon's physician network, contracting standards and processes and ensure timely and accurate responses to the Proposal Department.

What You Bring
Education/Experience:

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Require a Bachelor's degree from an accredited college or university with a major in business healthcare administration, finance, marketing or communications or comparable business experience.

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Requires 3-5 years experience in provider relations.

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Prior sales or marketing experience preferred.

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Additional licensing, certifications, registrations:

Knowledge:

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Require solid understanding of managed care principles, including capitation and PPOs.

- Require knowledge of healthcare industry

- Prefer knowledge of provider contracting

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Prefer knowledge of State and Federal healthcare regulations

- Prefer knowledge of major competitors

Skills and Abilities:

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Requires excellent written and verbal communication skills and excellent presentation skills.

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Requires the ability to work independently, set priorities and manage time effectively.

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Requires extensive PC skills, preferably with Microsoft Access, Lotus Notes, Microsoft Word and Excel or comparable software.

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Requires analytical skills necessary to evaluate trends, make recommendations and explain data.

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Requires problem-solving skills necessary to identify and resolve member or provider complaints or concerns.

- Prefers negotia