Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware
Job Summary:
Responsible for implementing, managing and retaining accounts/network through focus on analytics, performance metrics and a sustained compelling value offering.Responsibilities:
Conducts on-site visits and meetings to promote Dental education regarding utilization of the contracted network.
Develops strategies, tools and plans to execute sales and retention activities to meet enrollment goals.
Monitors and manages workflows and processes for high levels of execution in the areas of account maximization, contract compliance, performance metrics and deliverables and performs quality audits.
Functions as the primary Dental Product subject matter expert in the areas of data analysis, process improvement opportunities and implementation of training and remediation programs and processes.
Collaborates with management to develop, analyze, and transmit customized client/provider data reports.
Anticipates client needs and demonstrates leading edge understanding of developments, regulations, policies and procedures and cost containment strategies.
Performs other duties as assigned by management.
Commercial:
Utilizes client data, leverages market segmentation analysis to identify new Dental Sales opportunities and opportunities to cross sell to medical groups. The "Horizon Dental Product Champion"
Assists in the implementation of new accounts in coordination with the account management staff including client workflow meetings, workflow documents and customized client material.
Communicates with Horizon sales, account management staff and clients/brokers.
Medicaid:
This position will utilize knowledge of community resources to promote the use of efficient and effective quality dental delivery of treatment and services.
In the absence of the Dental Director, this person will assume responsibilities of the director with the exception of clinical matters.
Acts as the primary liaison between HNJH and Dental Vendor to address day to day operational issues.
Responsible for education, implementation and monitoring of Dental Vendor for service delivery and adherence to HNJH business requirements.
Conducts high-level assessment and planning for selected population-based members, example (MTLSS and Special needs) to initiate and discontinue care management services in both inpatient and outpatient settings, in addition to catastrophic incidents.
Negotiate fees for provider services on routine and specialty services for Par and Non Par Dental Providers.
Performs site visits as deemed necessary by the Dental Director.
Disclaimer:
This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job.
Education/Experience:
High School Diploma/GED required.
Bachelor degree preferred or relevant experience in lieu of degree.
Requires a minimum of four (4) years' experience in account management or Dental insurance industry.
Requires a minimum of five (5) years- experience in the dental health care delivery system/industry. (Medicaid Only)
Requires a minimum of five (5) years- experience in managed care or pre-certification in the dental field. (Medicaid Only)
Additional licensing, certifications, registrations:
Sales License, (must be obtained within 3 months of date of hire) - Commercial Only
Valid Driver License and access to a registered insured automobile.
Prefer a Dental Hygiene License - Medicaid Only
Knowledge:
Requires comprehensive working knowledge of account management.
Requires working knowledge of health and dental insurance industry.
Requires strong knowledge of dental healthcare delivery systems/industry.
Prefers knowledge of healthcare contracts and benefit eligibility.
Requires knowledge of utilization management.
Requires excellent customer service skills.
Skills and Abilities:
Requires strong analytical skills and the ability to report findings in a professional and concise manner.
Requires proven ability to effectively use automated technology, e.g. Windows based PC applications Word, Excel.
Requires effective verbal, written and public presentation skills.
Requires the ability to work independently and in a team environment.
Travel:
Required flexibility to travel to assigned accounts on an as needed basis.
Salary Range:
$76,800 - $102,795
This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This range has been created in good faith based on information known to Horizon at the time of posting. Compensation decisions are dependent on the circ*mstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes:
Comprehensive health benefits (Medical/Dental/Vision)
Retirement Plans
Generous PTO
Incentive Plans
Wellness Programs
Paid Volunteer Time Off
Tuition Reimbursem*nt
Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.
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.
