EmblemHealth is hiring

Contract Specialist job at EmblemHealth, New York

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  • Load all Professional, Facility, and Ancillary contracts across all EmblemHealth lines of business in a timely and accurate manner.  
  • Provide subject matter expertise in all areas of contract configuration, fee schedules/groupers, and rate reimbursement.
  • Collaborate on 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 Network.  
  • Develop expertise in the downstream impact of loaded rates within EmblemHealth’s full claims reimbursement cycle.  

Responsibilities:

  • Participate in all aspects of provider, facility, and ancillary rate configurations in Network within 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.
  • Identify and correct rate load problems.
  • Assist with the contract configuration, fee schedule / grouper, and rate reimbursement matters.
  • Analyze negotiated contracts to determine Network interaction with the core systems ensuring that reimbursement is in line with negotiated intent. 
  • In coordination with Network Management, update all evergreen contracts in a timely manner.
  • Recommend contract language changes to be in line with system reimbursement capabilities.
  • Coordinate rate testing with BTS.


Job Requirements:

Requirements:

  • B. S. degree in Business Operations, Information Systems or equivalent required; Master’s Degree a plus; equivalent experience and specialized certifications/trainings may be considered in lieu of the education requirement
  • Minimum 2-3 years of relevant experience required, preferably in a health care environment
  • Strong familiarity with 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
  • Analytic, problem solver, excellent organizational and technical skills and attention to detail are required required

Job country: United States

City: New York

Category: Business Operations Specialists, All Other

Location: New York, NY, United States

Job posted 2022-06-04

This job is expired

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