Contract Specialist - Remote

EmblemHealth; New York (NY); Remote; USD 48,000 - 84,000; Full time

Job summary

A health care organization located in New York is looking for a professional to manage contracts accurately across all business lines. This role requires expertise in contract configuration, reimbursement processes, and collaboration with multiple departments. The ideal candidate should possess a Bachelor's degree along with a minimum of 2-3 years in a relevant healthcare environment. Familiarity with claims systems and excellent analytic skills are essential for success.

Qualifications

• Minimum 2-3 years of relevant experience, preferably in a health care environment.
• Strong familiarity with EmblemHealth's claims systems and interdependent applications.
• Experience in provider, facility, and ancillary contract files set-ups.

Responsibilities

• Participate in all aspects of provider, facility, and ancillary rate configurations.
• Collaborate with Network Management and Analytics on contractual agreements capture.
• Identify and correct rate load problems.

Skills

Analytic skills

Problem solving

Organizational skills

Technical skills

Attention to detail

Education

B. S. degree in Business Operations or Information Systems

Master's Degree (a plus)

Job description

Overview

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.

Qualifications

• B. S. degree in Business Operations, Information Systems or equivalent
• Master's Degree a plus but not required
• Minimum 2-3 years of relevant experience, preferably in a health care environment (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)
• Analytic, problem solver, excellent organizational and technical skills and attention to detail (Required)

Additional Information

• Requisition ID: 1000002640_01
• Hiring Range: $48,600-$83,160