Provider Engagement & Network Relations Specialist

EmblemHealth; New York (NY); On-site; USD 80,000 - 110,000; Full time

Job summary

EmblemHealth is seeking a Provider Relations Specialist to act as a liaison between Providers and EmblemHealth, handling day-to-day operations for contracts, program implementations, and escalated provider issues.

The role covers contract loading, education on Plan policies, and coordination with multiple Plan departments to ensure timely, accurate responses and effective issue resolution.

Qualifications

• Bachelor's degree or higher in a healthcare-related field, public administration, or management.
• Experience in provider relations or contract management is preferred and valued.
• Strong customer service focus with the ability to build rapport with providers and staff.
• Excellent written and verbal communication to articulate requests and resolutions clearly.
• Ability to manage multiple projects and coordinate with multiple Plan departments.

Responsibilities

• Assist providers with contract disputes and ensure accurate contract and rate load implementations.
• Communicate with providers and respond promptly to inquiries with minimal direction.
• Support timely completion/coordination of claim inquiries and complaints across Hospital, Ancillary, and Professional networks.
• Provide accurate responses to provider requests for plan materials, fees, and provider resources.
• Lead and facilitate provider meetings to drive resolution of policy, payment, or contractual items.

Skills

Customer service

Communication skills

Time management

Interpersonal skills

Analytical/problem-solving

MS Excel proficiency

MS Word proficiency

Microsoft Office Suite

Education

Bachelor's degree in Healthcare-related field / Public Administration / Management

Tools

Excel

Word

Microsoft Office Suite

Job description

EmblemHealth is seeking a Provider Relations Specialist to act as a liaison between Providers and EmblemHealth, handling day-to-day operations for contracts, program implementations, and escalated provider issues.

The role covers contract loading, education on Plan policies, and coordination with multiple Plan departments to ensure timely, accurate responses and effective issue resolution.