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.

Senior Facility Specialist

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Manager & Professional
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191CT Requisition #
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Has day to day responsibility of receiving, tracking and responding to inquires received from assigned participating facility providers in downstate NY.  Assist in resolving operational issues, and educating providers on Emblemhealth policies, procedures and processes.

Responsibilities:
  • Responsible to research and summarize claims issues received by participating facility providers.  Summaries are to include volume and financial data to be used to tracking and reporting purposes.  Full and complete responses to be returned to facilities within the agreed upon timeframe.  
  • Establish a reasonable timeframe for completion of each project with facility provider, communicate timely and effectively and provide additional support to facility provider as deemed necessary in order to close issues.
  • Respond to SAWS and GAD memos timely and accurately in order to close internal issues.
  • Provide supporting information prior to scheduled meetings with participating facility providers and attend meetings when necessary.  Conducts appropriate follow ups as agreed to internally and with the facility.
  • Assist in training participating facilities on Emblemhealth policies, procedures and payment guidelines, website, and any other training needs that may arise.
  • Supports the Departmental Service Model with specific function(s) as assigned by Manager.
  • Special projects as assigned.
Qualifications:
  • BS required in Business Administration, Health Care Administration, Finance or related degree preferred
  • 3-5 years prior experience (managed care, health administration or health education) required
  • 3-5 years prior experience (contracting, provider and/or vendor management) required
  • Claims experience, knowledge of Claims processing and/or Claims administration 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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