Provider Contracting Specialist - Remote

EmblemHealth; New York (NY); Remote; USD 56,000 - 100,000; Full time

Job summary

An established industry player is seeking a Provider Contracting Specialist to serve as a vital link between providers and the organization. This remote role involves managing contracts, resolving provider issues, and ensuring smooth communication of policies. Ideal candidates will have a background in healthcare and strong interpersonal skills. Join a dynamic team dedicated to optimizing provider relations and enhancing operational efficiency in the healthcare sector. This position offers an exciting opportunity to make a significant impact in a collaborative environment.

Qualifications

• 3-5+ years of provider relations experience required.
• Knowledge of healthcare financing and access issues is essential.

Responsibilities

• Act as a liaison between providers and EmblemHealth.
• Assist with contract disputes and ensure timely implementations.

Skills

Customer Service

Communication Skills

Interpersonal Skills

Project Management

Healthcare Knowledge

Education

Bachelor’s degree in Healthcare

Bachelor’s degree in Public Administration

Bachelor’s degree in Management

Tools

Microsoft Office

Job description

Provider Contracting Specialist - Remote

Join to apply for the Provider Contracting Specialist - Remote role at EmblemHealth.

Job Summary

Act as a liaison and operate as a vital link between specific Facility, Ancillary, Delegated, and/or Professional providers and EmblemHealth. Responsible for day-to-day operations related to contracts, including contract optimization, implementation of new programs, provider issue resolution, education, and communication of policies and procedures. Serve as the contact for escalated issues such as grievances, disputes, and billing complaints from providers and internal departments.

Responsibilities

• Assist providers with contract disputes and ensure accurate and timely contract and rate load implementations.
• Respond to provider inquiries professionally and promptly.
• Coordinate claim inquiries, complaints, and audits for the network; support Joint Operating Committees and claim review processes.
• Collaborate with various Plan departments to resolve issues.
• Provide accurate responses to provider requests regarding Plan materials, fees, website, IVR, and provider manuals.
• Coordinate notification and education within the organization on contract terms and issues.
• Manage delegated credentialing activities.
• Ensure provider demographic data accuracy in the database; handle demographic changes and address discrepancies.
• Support recruitment efforts to fulfill network deficiencies.
• Perform outreach projects and document activities per standards.
• Perform other duties as assigned.

Qualifications

• Bachelor’s degree in Healthcare, Public Administration, or Management.
• 3-5+ years of provider relations experience.
• Knowledge of provider and payor roles, healthcare financing, access issues, and legislation.
• Excellent customer service, communication, and interpersonal skills.
• Ability to work independently and manage multiple projects.
• Proficiency in Microsoft Office applications.

Additional Information

• Requisition ID: 1000002416
• Salary Range: $56,160-$99,360

Job Details

• Seniority Level: Mid-Senior
• Employment Type: Contract
• Job Function: Legal
• Industry: Insurance