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.

Sr. Contracting Specialist

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Manager & Professional
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2019X Requisition #
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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. Fully comprehends the downstream impact of loaded rates within EmblemHealth’s full claims reimbursement cycle. Develops expertise and acts as a subject matter expect in NetworX.

 

Responsibilities

  • Responsible for all aspects of provider, facility, and ancillary rate configurations within NetworX within set deadlines, while ensuring full accuracy of contract loads. 
  • Collaborates 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.
  • Serves as a subject matter expert with all contract configuration, fee schedule / grouper, and rate reimbursement matters.
  • Analyzes negotiated contracts to determine NetworX interaction with the core systems ensuring that reimbursement is in line with negotiated intent.
  • In coordination with Network Management, ensures timely update of all evergreen contracts.
  • Recommends contract language changes to be in line with system reimbursement capabilities.
  • Coordinate rate testing with Business Technical Systems (BTS).

 

 

 

 

Qualifications

  • B. S. degree in Business Operations, Information Systems or equivalent; additional years of relevant experience, and/or specialized certifications/training, may be considered in lieu of the educational requirements
  • Master’s Degree a plus
  • Minimum 3-5 years of relevant experience, preferably in a health care environment required
  • Strong familiarity with EmblemHealth’s claims systems and interdependent applications preferred
  • Experience with Facets & NetworX a plus
  • 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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