Job Summary:
This position is accountable for behavioral health practitioner outreach, network recruitment, relationship management, issue identification and resolution, and problem avoidance. This includes maintaining effective relationships with all facets of the behavioral health professional provider community, including education, facilitation and resolution of complex, urgent problems and data integrity maintenance.
Responsibilities:
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Serves as the key external-facing member of the behavioral health network management team for the behavioral health professional network in their designated geographic area.
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Analyzes membership and geographical access by BH Specialty to determine specific goals and action plans for targeted recruitment of new practitioners, providing blueprint for contracting priorities and network growth targets.
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Performs activities that develop prospective relationships with providers by supporting and participating in the recruitment and maintenance of the behavioral health provider network. Provides input to behavioral health special payment arrangement contract renewals to improve the services that will maximize the potential for retention and initial provider enrollment.
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Informs and educates behavioral health practitioners on Horizon‘s products and services and is held accountable for influencing and accelerating the network adoption of related Horizon strategic efficiency initiatives including provider portal adoption and other self-service or automation related objectives. Engages in proactive outreaches to high volume behavioral health groups in their designated territories to build rapport and ensure providers are aware of any pertinent updates.
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Analyzes provider related information and data in order to recommend actions and solutions to strengthen the provider’s relationship with Horizon.
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Initiates communication with other members of BH network management team and representatives from appropriate areas to effectively troubleshoot complex claim situations, program/policy disputes, executive, and VIP and Regulatory inquiries to drive resolution and improve service quality.
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Alerts leadership to potential issues risks, and opportunities identified through behavioral health network interactions.
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Plans, organizes, and presents seminars to various BH network practitioners and groups, billing services, medical societies and internal groups.
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Maintains a thorough knowledge of healthcare industry trends and developments through the review of industry publications, newsletters and formal training.
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Identifies, researches, recommends and implements potential saving opportunities for the delivery of cost-effective and quality care that subsequently results in the generation of cost savings.
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Works closely with BH Network Leadership and BH network practitioners to facilitate dialogue pertaining to practice patterns and BH quality/outcomes measures.
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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.
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:
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High School Diploma/GED required.
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Bachelor degree preferred or relevant experience in lieu of degree.
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Requires a minimum of five (5) years healthcare experience, preferably with provider or client focus/interaction.
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Strongly prefer experience in healthcare provider recruitment.
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Prefers behavioral health related experience in the healthcare/insurance industry.
Knowledge:
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Requires knowledge of healthcare industry.
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Requires knowledge of New Jersey behavioral health provider community.
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Prefers knowledge of HBCBSNJ programs, products and procedures.
Travel:
Salary Range:
$76,800 - $102,795
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:
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.
