Company Statement

For the last 80 years, EmblemHealth has been taking care of New York’s heart and soul, its people. Today, health care is more complex than ever. That’s why we’re at the forefront of change. We work alongside our customers to offer access to high-quality, affordable care, help navigate the health care experience, and make good health achievable; because everyone deserves to be taken care of. We deliver on our mission every day by living our values with our colleagues, members, clients and partners. It begins with caring and respecting all those we work with. We believe a culture of diversity and inclusion is vital to serve our unique and diverse customers. We seek for continues improvement and innovation and believe being agile and nimble is our advantage. We bring a strong sense of partnership to every relationship – internally and externally. The EmblemHealth family of companies offers competitive health, welfare, and retirement benefits as well as incentive pay plans and more.

Behavioral Health Contracting Specialist

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Manager & Professional
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200CR Requisition #
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Recruit appropriate behavioral health providers for inclusion in the network.  Responsible for Contract execution, preparation and hand off to credentialing.  Provide expertise and support in the areas of behavioral health network adequacy requirements, contracting, fee schedules and negotiation.  Evaluate special rate requests including gathering pertinent information, making recommendations, and presentation to leadership.

Responsibilities:
  • Accountable for behavioral health contracting: outreach and engagement; standard rate reviews; and handling of special rate requests.  
  • Maintain ongoing provider relations.
  • Execute contracting recruitment strategies for professional behavioral health facilities.  
  • Track contract input and tracking until successful loading and set up in EmblemHealth’s systems.  
  • Serve as point of contact for contracting issues.
  • Provide expertise and support with behavioral health professional contracting matters.  
  • Interact with network behavioral health providers and facilities to address questions and concerns.  
  • Facilitate the resolution of open issues; provide guidance and recommendations.
  • Collaborate with internal departments to ensure proper capture of negotiated contractual agreements.  
  • Ensure efficient interaction with downstream systems including TruProvider, NetworX, and FACETs.  
  • Facilitate problem resolution including claims payments for network providers.
  • Facilitate the identification and correction of rate and other contract loading problems.
Qualifications:
  • Bachelor’s Degree
  • 3 – 5+ years of relevant behavioral health contracting experience, preferably in a health care environment required
  • Experience in facility and ancillary contract files set-ups, maintenance, testing and auditing functions required
  • Experience establishing and implementing business strategies to successfully translate contractual language into system reimbursement specifications preferred
  • Excellent knowledge of medical terminology, Fee Schedules, and ICD/CPT/HCPCS coding required
  • Proficiency with MS Office (word processing, database/spreadsheet, presentation) required
  • Understanding of Government reimbursement methodologies preferred
  • Analytic, problem solver, excellent organizational and technical skills and attention to detail are required

EEOC Statement

We are committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law.

Sponsorship Statement

Depending on factors such as business unit requirements, the nature of the position, cost and applicable laws and regulations, EmblemHealth may provide work visa sponsorship for certain positions.

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