Managed Care Contract Specialist

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West Trenton, NJ

NJM Insurance Group

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keywords: position summary,teamwork,management,support,reporting,experience,knowledge,skills,teamwork,degree,travel

Full Time

Overview: The Managed Care Contract Specialist is responsible for the managed care contract functions including negotiating new and existing direct contracts, developing successful relationships with PPO Vendor staff and working with them to resolve issues. The official NJM job title for this position is Provider Network Management and Performance Representative.&nbsp;<br /> <div id="gtx-trans" style="position: absolute; left: -714px; top: 26px;">&nbsp;</div>
Responsibilities: <ul> <li>Serves as the key resource for contracting and works on complex negotiations and drafts all contract documents. Works and meets with providers to resolved complex provider complaints. &nbsp;Researches and recommends appropriate vendors to support business expansion.&nbsp;</li> <li>Analyzes trending reports to identify outliers and areas of improvement. &nbsp;Collaborates with department analysts and impacted business units to create reports and support current and new regulatory guidelines for expansion states. &nbsp;</li> <li>Assists in coordinating providers to render care on legal and non-legal cases. &nbsp;Responds to inquiries from various Business Units to confirm the status of providers. &nbsp;Verifies providers&rsquo; status directly with PPO vendors as needed. &nbsp;Reviews out-of-network referrals and make recommendations for appropriate levels of reimbursement.</li> <li>Responsible for maintaining owned contracts in the contract management system and updating vendor checklists quarterly to ensure the information is recent and up to date.</li> <li>Oversees the maintenance of databases for provider look-up with the vendor. &nbsp;Makes appropriate changes and/or corrections to provider information received through the portal and updates information on the departmental spreadsheet. &nbsp;Sends updates to vendors and notify them of any technical issues with the lookup tool. &nbsp;Works with vendor on developing enhancements to provider information displayed.</li> </ul> <div id="gtx-trans" style="position: absolute; left: -91px; top: 26px;">&nbsp;</div>
Requirements: <ul> <li>Minimum of 1-2 years experience in member, provider and/or finance operations in a healthcare or Managed Care Organization</li> <li>Knowledge of Workers Compensation and/or PIP</li> <li>Travel within NJ and neighboring states</li> <li>Experience in multi-state PIP and/or Workers' Compensation strongly preferred</li> <li>Supervisory experience preferred</li> <li>Strong decision making and time management skills</li> <li>Strong ability to multi-task</li> <li>Advanced organizational skills</li> <li>Follow-up and follow-through skills</li> <li>Knowledge of MS Office skills including Word, Excel, PowerPoint, Visio, SAS</li> <li>Excellent communication skills (verbal and written)</li> <li>Ability to work effectively independently and as part of a team&nbsp;</li> <li>Bachelor&rsquo;s Degree and/or equivalent experience</li> </ul> <div id="gtx-trans" style="position: absolute; left: -166px; top: -20px;">&nbsp;</div>