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Physician Relations Representative I

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POST DATE 8/23/2016
END DATE 10/14/2016

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)
Bachelors Degree


Job Summary:

The Physician Relations Representative is field based and is responsible for maintaining effective relationships with all facets of the provider community. The position is responsible for provider education, facilitation and resolution of complex, urgent problems. In addition, the Provider Relations Representative ensures compliance with Federal and State guidelines pertaining to network adequacy. Must perform other assignments/projects as assigned by Management.


* Educate, monitor, analyze, document and interact with providers to ensure provider cooperation, understanding and effective participation in Horizon BCBSNJ products.

* Assist Management, Finance and Medical Leadership analyzing potential contracting arrangements and rate negotiations to ensure the delivery of cost effective, quality service.

* Establish strong, solid relationships with physicians/administrators at key provider offices within assigned territory.

* Coordinate with other members of the Provider Relations team and representatives from appropriate areas to effectively troubleshoot complex claim situations, program/policy disputes, executive, VIP and Regulatory inquiries.

* Participate in the planning, organizing and presentation of seminars, conventions, speeches, etc. to various provider, billing service, medical society and internal groups.

* Evaluate and identify opportunities for implementation of the various electronic initiatives and other key enterprise initiatives, available to assist providers with their daily interactions with Horizon BCBSNJ.

* Work closely with Medical Leadership and network physicians to facilitate significant practice patterns and cost effective healthcare delivery initiatives.

* Develop time and cost effective territory management programs that comply with department and enterprise goals.

* Maintain a thorough knowledge of healthcare industry trends and developments through the review of industry publications, newsletters and formal training.

* Perform other assignments/projects as assigned by Management.


* Requires knowledge of healthcare industry or health insurance industry.

* Requires knowledge of New Jersey hospital and physician community.

* Prefers knowledge of HBCBSNJ programs, products and procedures.

Skills and Abilities:

* Requires ability to work independently and to set and follow logical priorities.

* Requires strong organization skills.

* Requires clean and concise written and verbal communication skills.

* Requires ability to work well in a team environment.

* Requires good computer skills.

* Prefers working knowledge of Microsoft Office and Lotus Notes.


* Requires a Bachelor's degree in business, healthcare administration or any other related field. Internal applicants lacking a degree but who have related business experience and who have demonstrated performance above the contributor level will be considered.

* Requires a minimum of two (2) years provider relations field experience. Experience must include planning, organizing and public contact.

* Prefers marketing or sales experience in the healthcare/insurance industry.

Additional licensing, certifications, registrations:

* Must have access to an automobile and must maintain a current motor vehicle license.

Travel (If Applicable):

* 90% Travel required within assigned territory.

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.



Job Level
Individual Contributor

--Horizon NJ Health

Job Type
Full Time

Ewing, NJ