Horizon Blue Cross Blue Shield of NJ Manager, Provider Administration in Newark, New Jersey

Manager, Provider Administration

Job ID: KAL092018-12114

Description:

Job Summary:

This position will align and work closely with the HVS team to coordinate partnership implementation, post implementation support and data governance. This position will also work closely to align to the Governmental Programs Division, to ensure complex compliance and state requirements and objectives are met through the daily workflows and processes. Use of business process improvement techniques to identify, points of concern for evaluation, and bpi overview and update.

Responsibilities:

  • Monitor, analyze, and interpret various government-regulated programs requirements (Medicaid, Medicare and Managed Long-Term Services & Supports) that are supported and serviced within the Government Programs Division, to meet enterprise initiatives and goals.

  • Collaborate with internal partners/stakeholders to provide strategic Value Based Strategy inputs into relevant tactical data plans.

  • Regularly monitor and report on objective goals and performance metrics for Value Based Strategy plans and programs data management elements.

  • Develop, and coordinate recommended processes to develop enhanced operations and performance measures for tracking and trending VBS.

  • Building and developing sustainable and consistent business data requirements to be incorporated into long term application of VBS.

  • Monitor and facilitate complex OSC merger and acquisition data updates to provide seamless process.

  • Develop, and coordinate recommended processes to develop enhance operations and performance measures for tracking and trending VBS.

  • Experienced account management with current and new business models, around the new VBP design.

  • Managing relationships and operations between cross-functional departments internally and externally.

  • Please use generic text below for Manager/Supervisor roles, delete for non-people managers.

  • Manage, develop and train staff; develop and monitor goals; conduct annual performance reviews, and administers salaries for the staff.

Knowledge:

  • Requires knowledge of principal requirements of data governance.

  • 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

  • Must be proficient in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint) and Lotus Notes; Should be knowledgeable in the use of intranet and internet applications.

Skills and Abilities:

  • Requires the ability to communicate thoughts in a clear, concise manner both orally and in writing.

  • Prefer the ability to understand medical terminology and medical procedures.

  • Must have effective verbal and written communication skills and demonstrate the ability to work and lead well within a team.

  • Must demonstrate professional and ethical business practices, adherence to company standards, and a commitment to -personal and professional development.

  • Proven ability to exercise sound judgment and strong problem solving skills.

  • Proven ability to ask probing questions and obtain thorough and relevant information.

  • Proven analytical, research and problem solving skills a must.

  • Must demonstrate the ability to learn quickly and apply learning to new situations. Must exhibit flexibility to change as appropriate.

  • Must demonstrate the ability to effectively present information and respond to questions in large and small group settings, and at all organizational levels.

  • Demonstrated ability to make decisions with little need for direction and to function effectively as a team-oriented, self-starter working across cross-functional lines.

  • Exhibits proven leadership, delegation and project management skills.

Education:

  • Bachelor of Arts degree from an accredited educational institution.

Experience:

  • Requires a minimum of five (5) years business experience with emphasis in the Health Care/Insurance Industry.

  • Requires experience in successfully leading cross-functional teams to achieve improvements.

  • Prefers project leadership/management experiences.

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 LevelManager

Expertise--Healthcare Services

Job TypeFull Time

LocationNewark, 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.