Contract Specialist - New York, United States - EmblemHealth

EmblemHealth

Verified Company

New York, United States

3 weeks ago

Posted by:

Mark Lane

beBee recruiter

Summary of Position

Roles and Responsibilities

Participate in all aspects of provider, facility, and ancillary rate configurations in Network within 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.
Identify and correct rate load problems.
Assist with the contract configuration, fee schedule / grouper, and rate reimbursement matters.
Analyze negotiated contracts to determine Network interaction with the core systems ensuring that reimbursement is in line with negotiated intent.
In coordination with Network Management, update all evergreen contracts in a timely manner.
Recommend contract language changes to be in line with system reimbursement capabilities.
Coordinate rate testing with BTS.

Qualifications:

B. S. degree in Business Operations, Information Systems or equivalent
Master's Degree a plus but not required
Minimum 23 years of relevant experience, preferably in a healthcare environment required
Experience in provider, facility, and ancillary contract files setups, 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
Analytic, problem solver, excellent organizational and technical skills and attention to detail are required

Additional Information