Network Contracting Account Specialist

Horizon Connect @ Wall BCBSNJ

. Facilitate and lead negotiations with hospital, physician, and ancillary network providers .

Posted 10/12/2026full-timeRemote • United StatesMid-LevelSenior💰 $87,300 - $119,070 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in contract finance and reimbursement methodologies, including FFS, Medicare DRG, and value-based programs. Proficient in health care cost data analysis and technical document writing, with strong capabilities in developing and maintaining provider contracting policies.

Highest-signal resume keywords

Contract Finance ExpertiseHealth Care Cost Data AnalysisProvider Contracting Policies DevelopmentValue-Based Payment ContractingNegotiation Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Contract FinanceReimbursement MethodologiesHealth Care Cost Data AnalysisTechnical Document WritingProvider ContractingNegotiationClaims ReviewPricing ConfigurationOperational Deficiency AnalysisContract Template Management

Soft Skills

Analytical SkillsDetail-OrientedProblem-SolvingEffective CommunicationRelationship Building

Tools & Technologies

MS Office SuiteWindows Based SoftwareIntranet ApplicationsInternet Applications

Industry Keywords

Health Care IndustryManaged CareValue-Based ProgramsMedicareMedicaidHMOHospital FinanceInsurance RegulationsQuality Measurement ApproachesNew Jersey Health Care Community

About the role

Key responsibilities & impact

Facilitate and lead negotiations with hospital, physician, and ancillary network providers
Prepare contract rate proposals with Medical Economics, Actuary, Payment Model Evolution, and Provider Experience teams
Support fee-for-service and value-based payment contracting initiatives across Horizon lines of business
Facilitate execution and maintenance of network contracting strategy and policies
Implement contracts and special arrangements accurately across systems
Manage provider file maintenance requests, claims stops, and new hospital implementations
Review claims, configuration, provider mapping, and system-wide technical inefficiencies
Research operational deficiencies, identify root causes, and analyze fallout reports
Coordinate hospital, ancillary, and professional rate loads, pricing configurations, DRG updates, and contract storage
Resolve contract reporting, provider file maintenance, claims stop, and hospital implementation issues with matrix partners
Analyze contracts to identify medical cost savings and implement industry initiatives
Maintain provider contract language and templates and ensure contracts can be configured into core systems
Collaborate with Legal and Compliance on contract templates and regulatory requirements
Develop and implement provider contracting policies and procedures
Contribute to value-based contracting strategy and enterprise affordability objectives
Collaborate across departments to align provider services with member and organizational needs
Create materials for industry conferences, webinars, and other events

Requirements

What you’ll need

High School Diploma/GED required
Bachelor degree in business, finance, accounting, health administration preferred or relevant experience in lieu of degree
Preferred Master’s degree in health or business
Minimum of 5 years of business experience in hospital finance and/or managed care network development
Minimum 5 years demonstrated experience in two or more with in-depth knowledge and understanding of contract finance and reimbursement methodologies including FFS, Medicare DRG and APC’s, Medicaid pricing, capitation, full risk, shared savings and incentive arrangements
Minimum of 5 years provider experience in Commercial, Medicare, Medicaid, and Value Based Programs
Minimum of 5 years’ experience in health care cost data analysis and technical document writing
Proficiency in personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint)
Knowledge of intranet and internet applications
Knowledge of Principles of Health Care contracting
Knowledge of the health care or health insurance industry
Knowledge of hospital and physician communities in New Jersey
Knowledge of insurance, HMO, hospital and physician practice laws and regulations
Knowledge of quality measurement approaches applied in insurance, HMO, hospital and physician practice
Ability to create, develop, and maintain business relationships
Analytical, business case and product design skills
Ability to exercise sound judgment, ask probing questions, and obtain thorough and relevant information
Detail-oriented with strong organizational, problem-solving, organizational, and instruction-following skills
Ability to adapt to multiple responsibilities across multiple organizational areas
Ability to present information and respond to questions from groups of managers, clients, and customers
Effective verbal and written communication skills and ability to work well within a team
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware

Benefits

Comp & perks

Comprehensive health benefits (Medical/Dental/Vision)
Retirement Plans
Generous PTO
Incentive Plans
Wellness Programs
Paid Volunteer Time Off
Tuition Reimbursement
Moderate travel is required