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Hospital Relations Rep

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POST DATE 9/2/2016
END DATE 12/2/2016

Horizon Blue Cross Blue Shield of New Jersey Ewing, NJ

Ewing, NJ
AJE Ref #
Job Classification
Full Time
Job Type
Company Ref #
Mid-Career (2 - 15 years)
High School Diploma or GED


Job Summary:

This position is responsible for managing the relationships between Horizon NJ Health and hospitals. Interfaces with appropriate hospital representatives to maintain communication related to Horizon Blue Cross Blue Shield of New Jersey issues. Additionally responsible for understanding the hospitals' or other providers' role within the local community.


* Manages relationships with hospitals or other providers by addressing concerns and ensuring that provider contracts are adhered to and fulfilled.

* Functions as a liaison between the hospital/provider community and internal areas of Horizon Blue Cross Blue Shield of New Jersey and its business partners. Assists providers with claim issues such as incorrect payments, denials, authorizations, appeals, etc. Works with internal departments and TPA to resolve the claim issues and then communicates resolution to the provider.

* Introduces new products, and explains procedures to hospitals/providers to assure a premium level of customer satisfaction. Teams up with Hospital Account Executive and visits providers to give overviews on policies and procedures, new benefits, provider manual, website, etc. Conducts scheduled conference calls with providers to discuss claim issues.

* Conducts on-site visits to ensure continued satisfaction and coordinates educational seminars which address products, procedures and policies.

* Continually reviews, monitors and reports data received and recommends action plans as needed.

* Provides on-going consultation and advice to key hospital representatives including the patient accounts and managed care departments, and helps in the generation, evaluation and selection of ideas to address concerns and assists in the implementation of these ideas.

* Develops a working knowledge of the hospitals' strengths, weaknesses and roles within the communities and understands the full contract of services provided by the hospital and reimbursement associated with such services.

* Works with hospital or other provider representatives to review, address, and resolve accounts receivable issues. Provides relevant reporting to appropriate internal and external entities.

* Assists with Horizon Blue Cross Blue Shield of New Jersey IS initiatives by communicating system changes to hospitals or other providers.


* High School diploma or GED required, Bachelor's degree from an accredited college or university preferred.

* Requires 2 - 3 years experience in hospital or insurance industry with insight on hospital perspective.

* Requires 2 - 3 years experience in healthcare relations.

* Prefers experience in health care data analysis.

* Prefers field presentation experience in a professional setting management. .

Additional licensing, certifications, registrations:

* Requires valid Motor Vehicle driver-s license and access to an automobile.


* Requires knowledge of hospital reimbursement, principles, practices and methodologies.

* Requires prior experience supporting healthcare providers (hospital, physicians, ancillary services)

* Requires knowledge of medical terminology.

* Requires knowledge of various indemnities and managed care products.

* Prefer knowledge Federal and State regulations as they apply to the health insurance industry (Medicare, Medicaid, MLTSS, MLTC, DSNP).

* Prefer knowledge of health care industry policies and procedures.

Skills and Abilities:

* Requires customer service focus and a problem solving aptitude.

* Requires strong organizational and analytical skills.

* Requires excellent presentation, oral and written communication skills.

* Requires PC skills (Excel, Access and Word).

Travel (If Applicable):

* Requires 40% Travel

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.


High School Diploma, GED

Job Level
Individual Contributor


Job Type
Full Time

Ewing, NJ