Strategic Provider Contracts Specialist

EmblemHealth, Inc.; New York (NY); In loco; USD 56.000 - 99.000; Tempo pieno

Descrizione del lavoro

EmblemHealth, Inc. is seeking a Provider Relations professional in New York to manage day-to-day contract activities, provider communications, and coordination across departments.

This role supports contract optimization, implementation of new programs, and issue resolution with hospitals, providers, and staff. The position requires 3–5+ years in provider relations, strong communication and MS Office proficiency, and a commitment to quality care and payer relations.

Competenze

• 3-5+ years of direct provider relations experience (Required)
• Knowledge of provider and payor roles, responsibilities and challenges (Required)
• Understanding of health care financing, access issues, delivery systems, quality controls, and legislation (Required)
• Strong customer service skills and the ability to maintain an excellent rapport with providers and their staff (Required)
• Ability to work with various Plan departments is instrumental in effectiveness (Required)
• Excellent communication skills, written and verbal, to ensure requests are articulated (Required)
• Time management and flexibility to work on multiple projects, crisis readiness (Required)
• Interpersonal skills to maintain working relationships and resolve issues (Required)
• Proficiency in MS Office - Word, Excel, PowerPoint, Outlook, Teams, SharePoint, etc. (Required)

Mansioni

• Assist providers in all matters related to contract disputes and ensure accurate contract and rate load implementations.
• Communicate with providers and respond to inquiries timely, accurately and professionally.
• Support timely completion/coordination of claim inquiries and complaints for Hospital, Ancillary, and/or Professional network.
• Assist providers when issues require coordination with multiple Plan departments.
• Provide timely, useful responses to provider requests for materials, fees, and Plan information.
• Ensure and coordinate notification and education of Plan departments on contract terms and conditions.
• Coordinate delegated credentialing functions and activities.
• Ensure accuracy of provider demographic data in the Plan's database.
• Recruit providers to fulfill Network deficiencies if needed.
• Perform outreach projects and document activities in compliance with standards.

Conoscenze

Provider relations

Customer service

Communication

Time management

Interpersonal skills

MS Office

Formazione

Bachelor's degree in health care related field

Public Administration

Management

Strumenti

MS Office Suite

Descrizione del lavoro

EmblemHealth, Inc. is seeking a Provider Relations professional in New York to manage day-to-day contract activities, provider communications, and coordination across departments.

This role supports contract optimization, implementation of new programs, and issue resolution with hospitals, providers, and staff. The position requires 3–5+ years in provider relations, strong communication and MS Office proficiency, and a commitment to quality care and payer relations.