EmblemHealth · 1 day ago
Provider Contract Specialist - Hybrid
New York, NY
Contract
Hybrid
Mid Level
$56K/yr - $99K/yr
3+ years expEmblemHealth is a healthcare organization seeking a Provider Contract Specialist to serve as a liaison between providers and the company. The role involves managing contract operations, addressing provider issues, and ensuring effective communication of policies and procedures.
InsuranceNon ProfitWellness
Responsibilities
Assist providers in all matters related to contract disputes and ensure accurate contract and rate load implementations are done in a timely manner
Communicate with providers and respond to provider inquiries in a timely, accurate, and professional manner with minimal direction from leadership
Support the timely completion/coordination of claim inquiries and complaints for the Hospital, Ancillary, and/or Professional network; coordinate Joint Operating Committees (JOCs), claim review and resolution and support of audits when needed
Assist participating providers when issues require coordination of various Plan departments (Claims, Care Management, EDI, Grievance and Appeal, Customer Service, Enrollment, Special Investigations, Credentialing, etc.)
Provide timely, useful, and accurate responses to provider requests (provider requests for Plan materials; provider questions regarding fees, the Plan’s website and IVR; information in the Plan’s Provider Manual, and escalated claim inquiries
Ensure and coordinate notification and education of various departments within the EH on contract terms and related issues and conditions
Coordinate delegated credentialing functions and activities
Ensure the accuracy of provider demographic data in the Plan’s database: review provider data for assigned Providers; handle provider requests for demographic changes; research provider address discrepancies identified by provider returned mail and potential provider demographic errors identified by other Plan departments or initiatives
May recruit available providers to fulfill Network deficiencies
Perform outreach projects which may include requests by the Plan’s State Sponsored Programs Department for DOH, IPRO and DOI notices, HEDIS medical record retrieval and other projects as needed
Document all outreach activities in compliance with department standards
Perform additional duties as directed, assigned, or required
Qualification
Required
Bachelor's degree in health care - related field, Public Administration, Management, or equivalent
3 – 5+ years of direct provider relations experience (Required)
Knowledge of provider and payor roles, responsibilities and challenges (Required)
An 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 well with various Plan departments is instrumental in the effectiveness of the position (Required)
Excellent communication skills, written and verbal, to ensure that the appropriate requests are articulated and that problems are accurately represented for resolution (Required)
Time management skills and flexibility to work on multiple projects/assignments simultaneously, with ability to change focus in a crisis situation. Willingness to assume diverse duties and challenges (Required)
Interpersonal skills to effectively maintain working relationships to get issues resolved or to obtain information through people, and to represent the Plan and the Department in a favorable light (Required)
Ability to work independently assignments and maximize opportunities to support (Required)
Analytical and problem-solving skills to identify needs in provider relationships, make recommendations as projects develop and follow through to resolution using available resources to achieve a solution (Required)
Proficiency in MS Office - Word, Excel, PowerPoint, Outlook, Teams, SharePoint, etc. (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
2025-12-10
bloomberglaw.com
2025-12-06
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