What are the responsibilities and job description for the Payment Model Evolution Associate position at Horizon Blue Cross Blue Shield of New Jersey?
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware
Job Summary:
Payment Model Associates will help drive the innovative transformation of Horizon's provider payment landscape with the goal of enabling better affordability and quality of care while also contributing to improved member and provider experience. This Associate will be part of a team that will focus on strategic work aimed at aligning financial incentives and key network partnerships with behaviors that result in high provider network performance and improved engagement. The associate will help create value by building market, competitive and regulatory knowledge, developing training materials for internal and external stakeholders, and helping to instill culture changes needed to achieve the enterprise goal of growing value-based payment model arrangements.The Associate for Payment Model Evolution should have experience in executing payment model transformation work with a payor, health system, large provider group or managed service organization. This associate will be part of a team of that may consist of other specialists, and independent contributors. Excellent communication and collaboration skills are needed as this associate will work with a range of stakeholders both internally and externally.
This position will sit within the Payment and Clinical Transformation and Provider Experience tower reporting directly to a Manager / Director.
This job is a remote, or hybrid role with a preference for the person to reside in NJ, NY, CT, PA or DE. Limited travel required.Responsibilities:
Develop and execute approach for researching different payment models and strategies, and synthesize this research into comprehensive overviews and recommendations for payment evolution.
Create project charters, define deliverables, and structure and manage project plans to implement new/updated payment models which includes influencing and guiding matrix partners.
Synthesize payment model research into comprehensive overviews and recommendations for payment evolution.
Oversee education and training efforts tied to new payment model initiatives.
Create and maintain a repository for relevant policies, announcements and regulatory guidelines from relevant government agencies and share and present key learnings and updates with key internal stakeholders.
Assist in the design for fee-for-service and alternative payment models for relevant lines of business and provider types.
Understand and vocalize the enterprise payment transformation goals, be able to monitor and report on progress.
Assist with pilot projects, from ideation through implementation and ongoing management.
Collaborate with the Director, and Manager, Payment Model Evolution to create educational materials on strategies and train internal and external partners.
Assist the organization at industry conferences, webinars and other events as needed. Ensure that Horizon is well-positioned to identify and capitalize on emerging trends and opportunities in Horizon's market.
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.
High School Diploma/GED required.
Bachelor degree in business, finance, accounting, health administration preferred or relevant experience in lieu of degree.
Requires 5 years of relevant experience in healthcare consulting, alternative payment models, provider contracting, Medicaid/CMS regulations OR an MBA/MHA with a healthcare concentration.
Requires strong understanding of Value Based Payment models.
Requires 5 years experience in health care cost data analysis, ROI analysis, and technical document writing.
Prior market and competitive analysis experience required.
Preferred business experience in hospital finance and/or managed care network development.
Strong understanding of industry payment models including fee-for-service contracting models preferred.
Demonstrates ability to create, develop, and maintain business relationships.
Proven analytical and business case design skills a must.
Proven ability to exercise sound judgment.
Proven project management experience.
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.
Demonstrates flexibility and adapts to multiple responsibilities encompassing multiple areas within the organization.
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.
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.
Requires knowledge of Principals of Health Care contracting.
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.
Salary Range:
$93,000 - $127,050This 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:
Comprehensive health benefits (Medical/Dental/Vision)
Retirement Plans
Generous PTO
Incentive Plans
Wellness Programs
Paid Volunteer Time Off
Tuition Reimbursement
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.
Salary : $93,000 - $127,050
