Provider Contract & Network Strategist (Hybrid)

EmblemHealth; New York (NY); Hybrid; USD 68,000 - 119,000; Full time

Job summary

EmblemHealth is seeking a Senior Provider Contract Specialist to build, optimize and enhance our insurance networks across NY-NJ-CT. This role acts as a liaison between facilities, providers, and EmblemHealth, handling contract negotiations, program implementations, and provider education material.

The position requires a Bachelor's degree in a health care field and 4–6+ years in provider relations, with strong Excel and office-suite skills.

Qualifications

• Bachelor's degree in Health Care-related field is required.
• 4–6+ years of direct provider relations experience is required.
• Strong customer service skills and ability to maintain rapport with providers and their staff are required.
• Ability to work with multiple Plan departments is essential.
• Excellent written and verbal communication to articulate requests and resolve issues.
• Time management and flexibility to handle multiple projects simultaneously.

Responsibilities

• Recommend innovative contracting strategies to maximize cost containment, access and quality with provider arrangements.
• Negotiate contract terms, payment structures and reimbursement rates with providers.
• Monitor provider reimbursement methodologies and identify reimbursement trends for strategy development.
• Assist providers with contract disputes and ensure accurate contract and rate loads are implemented.
• Communicate with providers and respond to inquiries in a timely, accurate manner.
• Oversee network participation, performance analytics, renewals and terminations.
• Analyze the financial impact of contracts and terms.
• Coordinate timely handling of claim inquiries and complaints for Hospital, Ancillary and Professional networks.
• Coordinate delegated credentialing functions and ensure provider data accuracy.

Skills

Provider relations

Negotiation

Communication

Excel

Office suite

Education

Bachelor's degree in Health Care-related field

Job description

EmblemHealth is seeking a Senior Provider Contract Specialist to build, optimize and enhance our insurance networks across NY-NJ-CT. This role acts as a liaison between facilities, providers, and EmblemHealth, handling contract negotiations, program implementations, and provider education material.

The position requires a Bachelor's degree in a health care field and 4–6+ years in provider relations, with strong Excel and office-suite skills.