Horizon Blue Cross Blue Shield of NJ Network Operations Representative in Mount Laurel, New Jersey

Network Operations Representative

Job ID: KR072017-10160

Description:

Job Summary:

The Network Operations Representative is responsible for maintaining effective relationships with all facets of the provider community. The position is responsible for performing operational aspects related to Provider Relations functions. In addition, the Network Operations Representative ensures compliance with Federal and State guidelines pertaining to the network.

Responsibilities:

  • Educate, monitor, analyze, document and interact with providers to ensure provider cooperation, understanding and effective participation in Horizon BCBSNJ products.

  • Assist Management, Finance and Medical Leadership analyzing potential contracting arrangements and rate negotiations to ensure the delivery of cost effective, quality service.

  • Perform functions related to network adequacy such as demographic verifications, access/availability audits and claims analysis outreach.

  • Coordinate with other members of the Provider Relations team and representatives from appropriate areas to effectively troubleshoot complex claim situations, program/policy disputes, executive, VIP and Regulatory inquiries.

  • Prepare and submit reports to identify operational results.

  • Maintain a thorough knowledge of healthcare industry trends and developments through the review of industry publications, newsletters and formal training.

  • Perform other assignments/projects as assigned by Management.

Knowledge:

  • Requires knowledge of healthcare industry or health insurance industry.

  • Requires knowledge of New Jersey hospital and physician community.

  • Requires knowledge of claims system and contract configuration.

  • Prefers knowledge of HBCBSNJ programs, products and procedures.

Skills and Abilities:

  • Requires ability to work independently and to set and follow logical priorities.

  • Requires clean and concise written and verbal communication skills.

  • Requires ability to work well in a team environment.

  • Prefers working knowledge of Microsoft Office and Lotus Notes.

Education/Experience:

  • Prefers a Bachelor's degree in business, marketing, communications, healthcare administration or any other related field. Internal applicants lacking a degree but who have related business experience and who have demonstrated performance above the contributor level will be considered.

  • Prefers a minimum of two (2) years provider relations experience. Experience must include planning, organizing and public contact.

  • Prefers marketing or sales experience in the healthcare/insurance industry.

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.

Requirements:

EducationBachelors

Job LevelIndividual Contributor

Expertise--Horizon NJ Health

Job TypeFull Time

LocationMount Laurel, NJ

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.