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.

Lead Behavioral Health Contracting Specialist

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Professional / Leadership
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20066 Requisition #
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Responsible for Contract execution, preparation and hand off to credentialing. Serve as a subject matter expert in behavioral health network adequacy requirements, contracting, fee schedules and negotiation. Design and implement support for pre and post-contracting functions, including market research, fee analyses, responsibility determination, and contract performance. Work with stakeholders to elicit, analyze, communicate (document) and validate requirements for operational and financial analyses. Develop business processes to access special rate requests, determine impact on financials and make recommendations to management for inclusion or exclusion in the network. Develop workflows and business processes to ensure efficient interaction with downstream systems including TruProvider, NetworX, and FACETs.

 

Responsibilities:

  • Accountable for all aspects of behavioral health professional Contracting including outreach and engagement, standard rate reviews, handling of special rate requests and preparation of financial impact. 

  • Develop and execute contracting recruitment strategies for professional behavioral health facilities. 

  • Analyze negotiated contracts to determine interaction with the core systems, ensuring that reimbursement is in line with negotiated intent.

  • Track contract input and tracking until successful loading and set up in EmblemHealth’s systems.

  • Serve as team lead for value-based arrangements. 

  • Serve as point of contact for both financial and contracting issues.

  • Serve as a subject matter expert with all behavioral health professional contracting matters. 

  • Maintain and interact with network behavioral health providers and facilities to address questions and concerns. 

  • Facilitate the resolution of open issues. 

  • Collaborate with internal EmblemHealth departments to ensure proper capture of negotiated contractual agreements. 

  • Help with the identification and correction of rate and other contract loading problems.

  • Coordinates with EmblemHealth Legal on any requested or required contract language changes.

Qualifications:

  • Bachelor’s Degree

  • Minimum 5-8 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 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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