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. Facility Program Administrator

📁
Manager & Professional
📅
180001IL Requisition #
Sign Up for Job Alerts

This position has day to day responsibility for managing the relationships that supports the EmblemHealth hospital network in downstate NY.   There is daily, directly interaction with Emblemhealth’s hospital network, assisting in resolving operational issues, and educating providers on Emblemhealth policies, procedures and processes. The Sr. Facility Program Administrator shall serve as the primary point of contact between EmblemHealth and participating hospitals and delegated Vision vendors as assigned, to represent and advance EmblemHealth interests in the hospital provider market as the preferred plan through superior customer service and flawless execution of provider engagement strategies. Responsibilities include contract management; consultation on proactive approaches to improve financial, clinical and operational performance; providing education/training regarding company-wide initiatives, new products, regulatory standards, etc., and serving as an advocate for Hospital Providers within EmblemHealth.

 

Responsibilities:

  • Responsible for solving and responding to issues reported by participating facility providers timely, accurately and report reoccurring or systemic issues to Manager.

  • Responsible for delegated vendor vision contracts (4). Responsibilities include assisting in the negotiations of terms, maintaining current contract language and assuring that both parties adhere to the terms of the contract. Investigate and respond to inquiries from claims, customer service, G&A, and all other departments within HIP. Work closely with IT to test various new programs (FIDA, SelectCare) and their impact on the vendors. Oversight of delegates compliance with HIP due diligence and the delegation process, including annual audits and presenting documentation to the Delegation Oversight Committee.

  • Work proactively with the Financial Recovery Unit to understand and monitor financial overpayments made to the Hospitals. Track and recoup these funds from the hospitals. Understand root cause of the overpayments and ensure the systems are updated adequately to avoid potential future overpayments. Report overpayments to management.

  • Works closely with operational areas such as UM, Claims and GAD to ensure compliance with facility agreements.

  • Track and report on issues researched for participating providers including validation of financial impact for the purposes of reserving sufficient dollars.

  • Supports the Departmental Service Model with specific function(s) as assigned by Manager.

  • Assist in training participating facilities on Emblemhealth policies, procedures and payment guidelines, website, and any other training needs that may arise.

  • Plan for, coordinate and facilitate meetings with participating facility providers.  Report and track outcomes of meetings and follow up to ensure assigned tasks are completed and reported appropriately.

  • Special projects as assigned.

  • Regular attendance is an essential function of the job.  Performs other duties as assigned or required.

Qualifications:

  • BS required in Business Administration, Health Care Administration, Finance or related degree required

  • Masters strongly preferred

  • 4-6 years prior experience -managed care, health administration or health education including contracting, provider and/or vendor management required

  • Expertise leading group discussion with internal and external partners required

  • Ability to work independently and function effectively under pressure of tight deadlines and multiple initiatives required

  • Ability to anticipate and communicate regarding potential barriers in a timely fashion 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.

Previous Job Searches

Please try again.

Oops!

Either there was a problem on our end with the action you just performed, or we are currently having technical difficulties with our system. Please try again later.