Provider Network Specialist jobs in New Jersey

Provider Network Specialist coordinates and evaluates the contracts of a healthcare provider network. Participates in the negotiation of contracts and prepares reports and analysis of contract details and statistics. Being a Provider Network Specialist distributes contract information, status updates, and other information within the organization. Requires a bachelor's degree. Additionally, Provider Network Specialist typically reports to a manager or head of a unit/department. The Provider Network Specialist gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. To be a Provider Network Specialist typically requires 2 to 4 years of related experience. (Copyright 2024 Salary.com)

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Manager, Provider Network Development
  • Zelis Healthcare, LLC
  • Morristown, NJ FULL_TIME
  • 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.


    Zelis provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type 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.

     

  • 13 Days Ago

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Network Specialist
  • New Jersey Institute of Technology
  • Newark, NJ FULL_TIME
  • Title:Network SpecialistDepartment:Unified Communications & NetworkingReports To:Director, Unified Communications and Networking Position Type:StaffPosition Summary:Reporting to the Director of Unifie...
  • 1 Month Ago

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Provider- Radiation Oncology
  • Inspira Health Network
  • Vineland, NJ FULL_TIME
  • Provider- Radiation OncologyAt Inspira Health, you’ll join with the area’s most dedicated and distinguished team to bring quality and compassionate care to our communities. We focus on clinical excell...
  • 15 Days Ago

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Provider-Primary Care Deptford Prk
  • Inspira Health Network
  • Township of Deptford, NJ FULL_TIME
  • At Inspira Health, you’ll join with the area’s most dedicated and distinguished team to bring quality and compassionate care to our communities. We focus on clinical excellence, providing evidence-bas...
  • Just Posted

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Network and Telecommunications Support Specialist
  • County College of Morris
  • Randolph, NJ FULL_TIME
  • Posting Details Posting Summary Position Title Network and Telecommunications Support Specialist Job Category Support Staff Range Minimum $49,192 Position Type Full Time Department Information Systems...
  • 3 Days Ago

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IT SPECIALIST (NETWORK)
  • U.S. Army Communications Electronics Command
  • Fort Dix, NJ FULL_TIME
  • Duties Plan, implement, manage, evaluate IT support projects and their associated requirements and risks. Apply system architecture principles to develop and manage technical requirements. Coordinates...
  • 1 Month Ago

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Network Engineer/ Sr. Network Engineer/ Cloud Network Engineer/ Network Architect
  • SoftStandard Solutions
  • Employment Type: W2-Contract (Under SoftStandard Solutions Payroll) Rate: Post Screening, it will be decided. Location: ...
  • 3/25/2024 12:00:00 AM

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Provider Network Specialist-Hearing
  • NationsBenefits, LLC
  • Fort Lauderdale, FL
  • At NationsBenefits, we are committed to helping health plan members achieve a better quality of life through supplementa...
  • 3/25/2024 12:00:00 AM

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Network Engineer
  • HRUCKUS
  • Martinsburg, WV
  • Veteran Owned Firm Seeking a Network Engineer for Onsite Assignment in Martinsburg, WV My name is Stephen Hrutka and I a...
  • 3/25/2024 12:00:00 AM

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Network Engineer
  • Booz Allen Hamilton
  • Miami, FL
  • A well-designed and secure network is critical to moving data and enabling DoD to achieve its mission, but how can an or...
  • 3/24/2024 12:00:00 AM

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Network Engineer
  • Leidos
  • Albuquerque, NM
  • Description Leidos is seeking a mid-level Network Engineer to join our team. This is an excellent opportunity for someon...
  • 3/20/2024 12:00:00 AM

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Network Engineer
  • Leidos
  • Annapolis Junction, MD
  • Description Leidos is looking for a Mid-Senior Level Network Engineer to join a high performing agile team using the Sca...
  • 3/13/2024 12:00:00 AM

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Network Engineer
  • Leidos
  • Fort Meade, MD
  • Description Are you ready to make an impact and join a creative, forward-thinking team? We’re looking for innovators and...
  • 3/7/2024 12:00:00 AM

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Network Engineer
  • Leidos
  • Laurel, MD
  • Description Provides assistance in all aspects of network management from network design through implementation, mainten...
  • 2/6/2024 12:00:00 AM

New Jersey is bordered on the north and northeast by New York (parts of which are across the Hudson River, Upper New York Bay, the Kill Van Kull, Newark Bay, and the Arthur Kill); on the east by the Atlantic Ocean; on the southwest by Delaware across Delaware Bay; and on the west by Pennsylvania across the Delaware River. New Jersey is often broadly divided into three geographic regions: North Jersey, Central Jersey, and South Jersey. Some New Jersey residents do not consider Central Jersey a region in its own right, but others believe it is a separate geographic and cultural area from the Nor...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Provider Network Specialist jobs
$64,753 to $96,836

Provider Network Specialist in Anderson, IN
Creates, maintains, and ensures the integrity of the provider data in DHP’s multiple claims payments systems and provider interface programs.
January 07, 2020
Provider Network Specialist in Tucson, AZ
Identifies and works with the provider to address education needs relative to DHP’s new product lines/expansions, utilization management, claims submission, and back-end issues resolution requirements of each assigned provider’s contract.
January 12, 2020
The Provider Network Specialist will work closely with all facets of the business, primarily with Care Management, Claims and Business Development.
January 08, 2020
Provider Network Specialist in Oakland, CA
Build and maintain a successful working relationship with Integra Managed Care and network providers.
December 03, 2019