Provider Network Specialist jobs in Jersey City, NJ

Position Overview

Responsible for the overall strategy and development of Zelis contracted network providers (current and prospective) in an effort to increase the savings achieved for Zelis clients for existing and new products. Cultivate organization's' overall direct contracted PPO assets to support multiple products and achieve corporate objectives for PPO product viability.

Summary of Responsibilities

• Serve as a resource for all providers in a variety of markets, in particular large and key strategic groups and health systems, and national arrangements
• Negotiates complex contracts and coaches contracting team for network development efficiency.
• Executes corporate contracting strategy for multiple product lines (primary, OON, government, workers compensation, etc).
• Establish strategic relationships with all types of providers
• Answer complex questions and provide information about procedures or contracts
• Assist business operations with contract terms and educating company key personnel about such contract terms
• Develops and provides plan support and contracting leadership, as required.
• Compiles, maintains, and analyzes provider and hospital fee schedules to identify cost savings opportunities.
• Develops and communicates network development goals including target acquisitions, claim dollars captured, and revenue achieved.
• Provide continuous feedback and updates to organization's direct contract strategy.
• Create and manage tools necessary to capture provider targets, measure performance and provide feedback and recommendations to executive team.
• Recruit, coach and mentor Network Development staff. Initiates and effectively communicates a variety of human capital related actions including employment, termination, performance reviews, salary reviews, and disciplinary actions.
• Performs other duties as required.

Summary of Qualifications

• Bachelor's degree or equivalent experience.
• Advanced understanding of contract language and can explain according to audience
• In-Depth level of knowledge of Medicare reimbursement methodologies such as Resource Based Relative Value System (RBRVS), DRGs, Ambulatory Surgery Center Groupers, etc.
• In-Depth knowledge of provider contracting/negotiations, network development and configuration, standards for managed care delivery and cost containment programs.
• In-Depth knowledge of managed care policy and direction.
• Strong knowledge of product lines including group health, workers compensation, dental and government business.
• Management of strategic operational and technology initiatives.
• Strong working knowledge of MS Excel, computer systems, applications and operating systems.
• Experience managing projects and process innovative changes effectively.

EXPERIENCE

• Excellent communication skills both verbal and written, and skilled at developing and maintaining effective working relationships.
• Demonstrated thought leadership and motivation skills
• Self-starter
• Ability to research and resolve
• Excellent skills in critical thinking and analysis, project management, meeting facilitation, and interpersonal interactions (e.g., partnering, conflict management, consulting, etc.)
• Must be available to travel 25% - 50% as required to meet business needs.
• Evaluate and negotiate contracts in compliance with company contract templates, reimbursement structure standards, and other key process controls.
• Relocation assistance is provided for this position.

work environment

• A standard work week exists but with the understanding that additional time/effort outside of the usual parameters can/will occur based upon the overall needs of the integration, where deadlines exist and when necessary due to the needs of the integration team.
• A standard business environment exists with moderate noise levels.
• Ability to lift and move approximately thirty (30) pounds on a non-routine basis.
• Ability to sit for extended periods of time.

As a leading payments company in healthcare, we guide, price, explain, and pay for care on behalf of insurers and their members. We're Zelis in our pursuit to align the interests of payers, providers, and consumers to deliver a better financial experience and more affordable, transparent care for all. We partner with more than 700 payers, including the top-5 national health plans, BCBS insurers, regional health plans, TPAs and self-insured employers, over 4 million providers, and 100 million members, enabling the healthcare industry to pay for care, with care. Zelis brings adaptive technology, a deeply ingrained service culture, and a comprehensive navigation through adjudication and payment platform to manage the complete payment process.

Commitment to Diversity, Equity,Inclusion, and Belonging
At Zelis, we champion diversity, equity, inclusion, and belonging in all aspects of our operations. We embrace the power of diversity and create an environment where people can bring their authentic and best selves to work. We know that a sense of belonging is key not only to your success at Zelis, but also to your ability to bring your best each day.

Equal Employment Opportunity
Zelis is proud to be an equal opportunity employer. All applicants will receive consideration for employment without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

We encourage members of traditionally underrepresented communities to apply, even if you do not believe you 100% fit the qualifications of the position, including women, LGBTQIA people, people of color, and people with disabilities.

Accessibility Support

We are dedicated to ensuring our application process is accessible to all candidates. If you are a qualified individual with a disability or a disabled veteran and require a reasonable accommodation with any part of the application and/or interview process, please email TalentAcquisition@zelis.com

SCAM ALERT: There is an active nationwide employment scam which is now using Zelis to garner personal information or financial scams. This site is secure, and any applications made here are with our legitimate partner. If you're contacted by a Zelis Recruiter, please ensure whomever is contacting you truly represents Zelis Healthcare. We will never asked for the exchange of any money or credit card details during the recruitment process. Please be aware of any suspicious email activity from people who could be pretending to be recruiters or senior professionals at Zelis.