Physician Contracting Spec at Horizon Blue Cross & Blue Shield in Hopewell, NJ
Job
Summary:
This position is accountable for overseeing the control of all financial activities associated with Horizon Blue Cross Blue Shield of New Jersey's Health Care Management Provider Strategy and Network Development. Directs the forecasting, monitoring, financial reporting and reconciliation's of all Level I, II, and III physician incentive programs, single specialty networks and risk contracts. Designs, develops, and maintains physician special arrangement contracting, and the negotiations and implementation associated with professional and hospital based physician groups, including the review of financial impact analysis and the financial reporting of the Provider Strategy initiatives for the North and Southern regions
Responsibilities:
Reviews and presents all Managed Care Provider Strategy financial analysis and reporting. Develops and maintain the integrity of financial targets for the Level I, II and III physician Incentive programs and contracts. Ensures the accurate accounting of all financial activities related to the Provider Strategy. Coordinates the review of current and historic medical utilization and cost to assess trends of the Managed Care network, as compared to the physician incentive program results. Designs forecasting models to monitor and report financial performance for physician groups, single specialty networks and risk contracts. Manages the process of monitoring and maintaining financial impact analysis and reporting of all physician group special arrangements for the north and southern regions. Provides oversight, direction, and development associated with physician special arrangement contracting. Directly negotiates physician special arrangement contracts and oversees implementation of professional and hospital based physician groups. Directs the activities in the areas of financial due diligence and liquidity ratio analysis to establish and monitor the financial statements of potential and implemented contracts associated with physician single specialty networks and risk contracting. Responsible for the reporting of initial results and on going appropriate financial recommendations to senior management. Provides internal presentations and maintains external relationships and communication associated with the Provider Strategy initiatives. Assists in the development and implementation of Provider Strategy initiatives by establishing financial return on investment (ROI) calculations and creative financial model alternatives to assess reimbursement and competitive environment impacts in accomplishing strategic objectives. Education/
Experience:
Bachelor Degree in Accounting/Finance preferred or relevant work experience required in lieu of degree. Prefers CPA. Requires a minimum of seven (7) years managed care experience including familiarity with the development and implementation of a variety of risk sharing and provider incentive programs. Requires a minimum of five (5)) years business experience in contract development and negotiation. Additional licensing, certifications, registrations:
Prefers a CPA. Knowledge:
Requires in-depth knowledge of the managed care philosophy and principles. Requires a broad knowledge of GAAP/STAT financial accounting and finance. Requires a thorough understanding of managed care policies and procedures. Requires general knowledge of management information systems. Skills and Abilities:
Requires excellent presentation, oral and written communication skills. Requires strong negotiation skills. Requires the ability to think analytically and creatively. Requires strong organizational skills. Requires strong interpersonal skills. Requires the ability to manage and motivate other. 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.
Salary Range:
$80K -- $100K
Minimum Qualification
Allied Health Professionals, Accounting, Corporate FinanceEstimated Salary: $20 to $28 per hour based on qualifications.
Summary:
This position is accountable for overseeing the control of all financial activities associated with Horizon Blue Cross Blue Shield of New Jersey's Health Care Management Provider Strategy and Network Development. Directs the forecasting, monitoring, financial reporting and reconciliation's of all Level I, II, and III physician incentive programs, single specialty networks and risk contracts. Designs, develops, and maintains physician special arrangement contracting, and the negotiations and implementation associated with professional and hospital based physician groups, including the review of financial impact analysis and the financial reporting of the Provider Strategy initiatives for the North and Southern regions
Responsibilities:
Reviews and presents all Managed Care Provider Strategy financial analysis and reporting. Develops and maintain the integrity of financial targets for the Level I, II and III physician Incentive programs and contracts. Ensures the accurate accounting of all financial activities related to the Provider Strategy. Coordinates the review of current and historic medical utilization and cost to assess trends of the Managed Care network, as compared to the physician incentive program results. Designs forecasting models to monitor and report financial performance for physician groups, single specialty networks and risk contracts. Manages the process of monitoring and maintaining financial impact analysis and reporting of all physician group special arrangements for the north and southern regions. Provides oversight, direction, and development associated with physician special arrangement contracting. Directly negotiates physician special arrangement contracts and oversees implementation of professional and hospital based physician groups. Directs the activities in the areas of financial due diligence and liquidity ratio analysis to establish and monitor the financial statements of potential and implemented contracts associated with physician single specialty networks and risk contracting. Responsible for the reporting of initial results and on going appropriate financial recommendations to senior management. Provides internal presentations and maintains external relationships and communication associated with the Provider Strategy initiatives. Assists in the development and implementation of Provider Strategy initiatives by establishing financial return on investment (ROI) calculations and creative financial model alternatives to assess reimbursement and competitive environment impacts in accomplishing strategic objectives. Education/
Experience:
Bachelor Degree in Accounting/Finance preferred or relevant work experience required in lieu of degree. Prefers CPA. Requires a minimum of seven (7) years managed care experience including familiarity with the development and implementation of a variety of risk sharing and provider incentive programs. Requires a minimum of five (5)) years business experience in contract development and negotiation. Additional licensing, certifications, registrations:
Prefers a CPA. Knowledge:
Requires in-depth knowledge of the managed care philosophy and principles. Requires a broad knowledge of GAAP/STAT financial accounting and finance. Requires a thorough understanding of managed care policies and procedures. Requires general knowledge of management information systems. Skills and Abilities:
Requires excellent presentation, oral and written communication skills. Requires strong negotiation skills. Requires the ability to think analytically and creatively. Requires strong organizational skills. Requires strong interpersonal skills. Requires the ability to manage and motivate other. 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.
Salary Range:
$80K -- $100K
Minimum Qualification
Allied Health Professionals, Accounting, Corporate FinanceEstimated Salary: $20 to $28 per hour based on qualifications.
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