Behavioral Health Network Specialist

Horizon Healthcare Services•Hopewell, NJ

8d•Hybrid

About The Position

This position is accountable for behavioral health practitioner outreach, network recruitment, relationship management, issue identification and resolution, and problem avoidance. This includes maintaining effective relationships with all facets of the behavioral health professional provider community, including education, facilitation and resolution of complex, urgent problems and data integrity maintenance

Requirements

High School Diploma/GED required.
Requires a minimum of five (5) years healthcare experience, preferably with provider or client focus/interaction.
Requires knowledge of healthcare industry.
Requires knowledge of New Jersey behavioral health provider community.

Nice To Haves

Bachelor degree preferred or relevant experience in lieu of degree.
Candidates with current or previous Behavioral Health experience including provider and facility outreach and/or provider/network recruiting strongly preferred.
Prefers behavioral health related experience in the healthcare/insurance industry.
Prefers knowledge of HBCBSNJ programs, products and procedures.

Responsibilities

Serves as the key external-facing member of the behavioral health network management team for the behavioral health professional network in their designated geographic area.
Analyzes membership and geographical access by BH Specialty to determine specific goals and action plans for targeted recruitment of new practitioners, providing blueprint for contracting priorities and network growth targets.
Performs activities that develop prospective relationships with providers by supporting and participating in the recruitment and maintenance of the behavioral health provider network.
Provides input to behavioral health special payment arrangement contract renewals to improve the services that will maximize the potential for retention and initial provider enrollment.
Informs and educates behavioral health practitioners on Horizon‘s products and services and is held accountable for influencing and accelerating the network adoption of related Horizon strategic efficiency initiatives including provider portal adoption and other self-service or automation related objectives.
Engages in proactive outreaches to high volume behavioral health groups in their designated territories to build rapport and ensure providers are aware of any pertinent updates.
Analyzes provider related information and data in order to recommend actions and solutions to strengthen the provider’s relationship with Horizon.
Initiates communication with other members of BH network management team and representatives from appropriate areas to effectively troubleshoot complex claim situations, program/policy disputes, executive, and VIP and Regulatory inquiries to drive resolution and improve service quality.
Alerts leadership to potential issues risks, and opportunities identified through behavioral health network interactions.
Plans, organizes, and presents seminars to various BH network practitioners and groups, billing services, medical societies and internal groups.
Maintains a thorough knowledge of healthcare industry trends and developments through the review of industry publications, newsletters and formal training.
Identifies, researches, recommends and implements potential saving opportunities for the delivery of cost-effective and quality care that subsequently results in the generation of cost savings.
Works closely with BH Network Leadership and BH network practitioners to facilitate dialogue pertaining to practice patterns and BH quality/outcomes measures.
Drives communication with pertinent staff and managers to ensure that interdependencies between the departments, other projects and functional work are accurately identified and addressed, and provides status reports to management.