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 - Remote
Summary of Position
We are seeking a dynamic Contract Specialist who will be responsible for loading all Professional, Facility, and Ancillary contracts across all EmblemHealth lines of business in a timely and accurate manner. This individual will provide subject matter expertise in all areas of contract configuration, fee schedules/groupers, and rate reimbursement. The Contract Specialist collaborates 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 the Network. This individual will also develop expertise in the downstream impact of loaded rates within EmblemHealth’s full claims reimbursement cycle.
Roles and 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.
Qualifications
- B. S. degree in Business Operations, Information Systems or equivalent
- Master’s Degree a plus but not required
- Minimum 2-3 years of relevant experience, preferably in a healthcare 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
Security Disclosure
If you are offered a job from one of the EmblemHealth family of companies that includes ConnectiCare, AdvantageCare Physicians, and WellSpark, the offer confirmation email will come from “HRTalentAcquisition” with the subject line: “Offer of Employment for (job title)” – Please respond online”.
We never ask you to join a Google Hangout, request you to purchase your own equipment or pay to apply. We do not send email from a third-party email service such as Yahoo or Gmail.
Pay Disclosure
A good faith estimate of the compensation range for individuals hired to work for the EmblemHealth Family of Companies is provided. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate’s work experience, education/training, internal peer equity, and market and business considerations. The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. It is not typical for an individual to be hired at or near the top of the range, as compensation decisions depend on each case’s facts and circumstances. Union roles covered by a collective bargaining agreement will compensate in accordance with the union contract.
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/gender, sexual orientation, gender identity or expression, pregnancy or related condition, marital status, 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.