Company Statement
EmblemHealth is one of the nation’s largest not for profit health insurers, serving members across New York’s diverse communities with a full range of commercial and government-sponsored health plans for employers, individuals, and families. With a commitment to value-based care, EmblemHealth partners with top hospitals and doctors, including its own AdvantageCare Physicians, to deliver quality, affordable, convenient care. At over a dozen EmblemHealth Neighborhood Care locations, members and non-members alike have access to community-based health and wellness guidance and resources. For more information, visit emblemhealth.com.
Sr. Contract Specialist
🔍 New York, New York
Summary of Job
Responsible for timely and accurate load of all Professional, Facility, and Ancillary contracts across all EmblemHealth lines of business. Serve as a subject matter expert in all areas of contract configuration, fee schedules/groupers, and rate reimbursement. Develop 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 NetworX. Serve as the subject matter expert in NetworX.
Responsibilities:
- Responsible for all aspects of provider, facility, and ancillary rate configurations within NetworX in accordance with 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.
- Responsible for the identification and correction of rate load problems.
- Serve as a subject matter expert with all contract configuration, fee schedule / grouper, and rate reimbursement matters.
- Analyze negotiated contracts to determine NetworX interaction with the core systems, ensuring that reimbursement is in line with negotiated intent.
- Coordinate with Network Management to ensure timely update of all evergreen contracts.
- Recommend contract language changes to align with system reimbursement capabilities.
- Coordinate with all EmblemHeatlh towers on related NetworX issues.
Qualifications:
- B. S. degree in Business Operations, Information Systems or related
- 3 – 5+ years of relevant experience, preferably in a health care environment (Required)
- Additional experience or specialized training may be considered in lieu of educational requirements (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)
- Strong attention to detail; strong organizational, analytic, technical, and problem‐solving skills (Required)
- Proficient with MS Office (Word, Excel, PowerPoint, Outlook, Teams, SharePoint, etc.) (Required)
- Strong communication skills (verbal, written, presentation, interpersonal) with all types/levels of audiences (Required)
Security Disclosure
If you receive a job offer from EmblemHealth, the email will be from “HRTalentAcquisition” with the subject: “Offer of Employment for (job title) – Please respond online.” We will never ask you to join a Google Hangout, buy your own equipment, or pay to apply. We also do not use third-party email services like Yahoo or Gmail.
Pay Disclosure
At EmblemHealth, we prioritize transparency in our compensation practices. We provide a good faith estimate of the salary range for potential hires, which is based on key factors such as role responsibilities, candidate experience, education and training, internal equity, and market conditions. Please be aware that this estimate doesn’t account for geographic differences related to your work location. Typically, new hires may not start at the top of this range, as compensation is tailored to each individual's circumstances. For union positions, salaries will be determined according to the collective bargaining agreement. Join us at EmblemHealth, where your contributions are valued and supported by fair compensation.
EEOC Statement
We value the diverse backgrounds, perspectives, and experiences of our workforce. As an equal opportunity employer, we consider all qualified applicants for employment regardless of race, color, religion, sex, sexual orientation, gender identity, pregnancy, marital status, national origin, disability, veteran status, or any other protected characteristic protected by law.
Sponsorship Statement
EmblemHealth may provide work visa sponsorship depending on factors such as business unit requirements, position nature, costs, and applicable laws and regulations.