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.

Contract Specialist

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Healthcare Operations
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2105S Requisition #
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  • Load all Professional, Facility, and Ancillary contracts across all EmblemHealth lines of business in a timely and accurate manner.  
  • Provide subject matter expertise in all areas of contract configuration, fee schedules/groupers, and rate reimbursement.
  • Collaborate on workflows and business processes to ensure efficient interaction with Network Development, Analytics, and other business areas to facilitate accurate translation and maintenance of contractual agreements into Network.   
  • Develop expertise in the downstream impact of loaded rates within EmblemHealth’s full claims reimbursement cycle. 
Responsibilities:
  • Participate in all aspects of provider, facility, and ancillary rate configurations in Network within set deadlines, while ensuring full accuracy of contract loads.
  • Collaborate with Network Management and Analytics to ensure proper capture of negotiated and modeled contractual agreements.
  • Identify and correct rate load problems.
  • Assist with the contract configuration, fee schedule / grouper, and rate reimbursement matters.
  • Analyze negotiated contracts to determine Network interaction with the core systems ensuring that reimbursement is in line with negotiated intent. 
  • In coordination with Network Management, update all evergreen contracts in a timely manner.
  • Recommend contract language changes to be in line with system reimbursement capabilities.
  • Coordinate rate testing with BTS.

Requirements:

 

  • B. S. degree in Business Operations, Information Systems or equivalent required; or equivalent years of relevant experience and specialized certifications/trainings, may be considered in lieu of the educational requirement
  • Minimum 2-3 years of relevant experience, preferably in a health care environment required; Strong familiarity with EmblemHealth’s claims systems and interdependent applications required
  • Experience in provider, facility, and ancillary contract files set-ups, maintenance, testing and auditing functions required
  • Experience in establishing and accomplishing business strategies to successfully translate contractual language into system reimbursement specifications required
  • Excellent knowledge of medical terminology, Fee Schedules, and ICD/CPT/HCPCS coding required
  • Understanding of Government reimbursement methodologies required
  • 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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