EmblemHealth · 1 month ago
Senior Contract Specialist, Contract Configuration - Hybrid
New York, NY
Contract
Hybrid
Mid, Senior Level
$56K/yr - $99K/yr
3+ years expEmblemHealth is seeking a Senior Contract Specialist to manage the timely and accurate loading of contracts across all lines of business. The role involves serving as a subject matter expert in contract configuration and working closely with various teams to ensure the accuracy of contractual agreements.
InsuranceNon ProfitWellness
Responsibilities
Responsible for all aspects of provider, facility, and ancillary rate configurations within NetworX in accordance with 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
Responsible for the identification and correction of rate load problems
Serve as a subject matter expert with all contract configuration, fee schedule / grouper, and rate reimbursement matters
Analyze negotiated contracts to determine NetworX interaction with the core systems, ensuring that reimbursement is in line with negotiated intent
Coordinate with Network Management to ensure timely update of all evergreen contracts
Recommend contract language changes to align with system reimbursement capabilities
Coordinate with all EmblemHeatlh towers on related NetworX issues
Qualification
Required
B.S. degree in Business Operations, Information Systems or related
3 – 5+ years of relevant experience, preferably in a health care environment (Required)
Additional experience or specialized training may be considered in lieu of educational requirements (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)
Strong attention to detail; strong organizational, analytic, technical, and problem‐solving skills (Required)
Proficient with MS Office - Word, Excel, PowerPoint, Outlook, Teams, SharePoint, etc. (Required)
Strong communication skills - verbal, written, presentation, interpersonal) with all types/levels of audiences (Required)
Company
EmblemHealth
EmblemHealth is an insurance and wellness company that offers health benefits to consumers, employers, and government purchasers.
1001-5000 employees
H1B Sponsorship
EmblemHealth has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2024 (2)
2023 (2)
2021 (2)
2020 (4)
Funding
Current Stage
Late StageLeadership Team
M
Michael Collins
Vice President CRM Applications
Recent News
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