Horizon Blue Cross Blue Shield of New Jersey · 15 hours ago
Provider Account Specialist
United States
Full-time
Remote
Mid Level
$87K/yr - $119K/yr
3+ years expHorizon Blue Cross Blue Shield of New Jersey empowers members to achieve their best health and is seeking a Provider Account Specialist. This role involves supporting the Provider Account Manager in building relationships with healthcare providers, ensuring high-quality deliverables, and managing provider account activities to improve satisfaction and performance.
Health Care
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 communication with other members of the Physician Relations team and representatives from appropriate areas to effectively troubleshoot complex claim situations, program/policy disputes, executive, VIP and Regulatory inquiries to drive resolution and improve service quality
Leads internal & external meetings to review and discuss and resolve provider concerns and goals
Manages and supports cross-functional teams within a matrix reporting structure to define a collaborative engagement strategy, develop solutions and prioritize core work areas
Resolves provider inquiries through research and collaboration with all appropriate stakeholders
Maintains a tracking grid that assists leadership in identifying trends to help facilitate cross-functional solution and process improvement(s)
Works with Leadership to communicate outcome of inquiry to appropriate internal and external stakeholders
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
Understand the basic fundamentals of value-based care programs
Responsible for maintaining dashboards on value-based performance, patient outcomes, and financial metrics to identify trends and opportunities for improvement. Presenting findings and recommendations to management
Accountable for supporting the integration of the Value-based Partnership, Care Delivery Transformation, Health Affairs, Analytics and other areas, as necessary, to help achieve results within our value-based programs and partnerships
Foster high integrity relationships and drive successful implementation of patient-centered provider agreements with the goal of improving quality, cost, and service to members
Drive successful implementation of our innovative provider agreements, which are new models of reimbursement and care delivery
Work with internal leaders in developing and implementing alternative payment models to support delivery system transformation
Evaluate trends and performance data, including total cost of care and quality metrics, to identify key performance drivers and improvement opportunities
Support critical network activities including demographic updates, re-credentialing, contract renewals, and training
Create and maintain provider onboarding and orientation materials
Serves as the key external-facing member of cross-functional/divisional team of designated resources assigned to manage all aspects of Affiliation, Reimbursement, Education, and Inquiry Resolution for all physicians within specialty team
Qualification
Required
High School Diploma/GED required
Requires a minimum of 3 years' experience in healthcare industry, including knowledge of healthcare delivery systems, medical terminology, reimbursement processes, and regulatory requirements
Requires a minimum of 3 years' experience in successfully collaborating with cross-functional teams to achieve improvements or relevant experience in lieu of 3 years' experience
Requires a minimum of 2 years' of experience trouble shooting complex service inquiries
Requires a minimum of 3 years' demonstrated proficient experience working with external accounts, clients or provider partners
Must be proficient in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint)
Requires knowledge of health care industry or health insurance industry
Requires knowledge of the hospital and physician communities in the state of New Jersey
Requires knowledge of laws and regulations regulating insurance, HMO hospital and physician practice
Requires knowledge of quality measurement approaches applied in measuring insurance, HMO, hospital and physician practice
Strong organization skills are mandatory
Demonstrates ability to assist in all aspects of the Provider Experience team
Demonstrates ability to create, develop, and maintain business relationships in the Provider space
Proven ability to exercise sound judgment
Proven ability to ask probing questions and obtain thorough and relevant information
Must be detail oriented with strong organizational skills
Proven ability to follow detailed instructions is essential, along with proven problem solving skills
Must demonstrate the ability to effectively present information and respond to questions from groups of managers, clients, customers
Must have effective verbal and written communication skills and demonstrate the ability to work well within a team
Preferred
Bachelor degree preferred or relevant experience in lieu of degree
Preferred contracting knowledge
Preferred prior Provider experience
Preferred experience in health care cost data review and interpretation
Preferred knowledge of Health Care contracting
Familiarity with healthcare information technology systems, electronic health records (EHRs), and healthcare data management
Preferred project management skills and ability to manage multiple projects and initiatives simultaneously, ensuring timely and successfully completion
Benefits
Comprehensive health benefits (Medical/Dental/Vision)
Retirement Plans
Generous PTO
Incentive Plans
Wellness Programs
Paid Volunteer Time Off
Tuition Reimbursement
Company
Horizon Blue Cross Blue Shield of New Jersey
Horizon Blue Cross Blue Shield of New Jersey is a company that provides health insurance products.
5001-10000 employees
Funding
Current Stage
Late StageLeadership Team
Gary St. Hilaire
President & Chief Executive Officer
Recent News
2026-01-06
2025-12-29
2025-12-25
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