Supports the contract development, implementation and ongoing relationship management of EmblemHealth ACO/Shared Savings/Shared Risk contracts with provider entities. The role requires a unique mix of strong analytic capabilities, relationship management, and a fundamental understanding of the clinical, economic, and quality components of healthcare. Will utilize clinical, financial, and quality data to identify and communicate areas of opportunity to the provider entities. The incumbent will then collaboratively develop action plans to include targeted goals and interventions to impact these opportunities by coordinating health plan and provider entity resources. In addition, the ACO Senior Contract Administrator will serve as the relationship manager for all service-related issues for this group, including management of all day to day contract operations, including credentialing, claims payment accuracy, negotiations, provider file accuracy, and all other regulatory or provider education requirements.
In coordination with provider entities, Clinical Director, and Provider Clinical Navigator identify and implement clinical intervention programs and track ongoing progress. Resolve any internal and external barriers to promote effective use of clinical interventions and positive contract performance.
Manage day-to-day contract administration issues for Shared Savings providers; including provider file operations management, credentialing, contract implementations, provider education, and member grievance and appeals.
Utilize clinical and financial reports to identify opportunities for improvement with provider entities engaged in ACO arrangements. Understand and vet data in advance of distribution to provider organizations. Present complex data and findings to provider clinical and executive leadership teams.
Act as point person for data and report questions from provider entities. Collaborate with provider entities to produce ad-hoc or follow-on analyses which support their contract goals and progress tracking.
Coordinate and facilitate all internal and external meetings related to contract performance, consistent with contract stipulations.
Work with Director of Shared Savings Programs to identify and implement additional Shared Savings contract opportunities.
Bachelor's Degree in Healthcare or Business field required
Master's Degree, a plus but not required
10 years of experience may be substituted in lieu of a degree
Minimum Four to Six years' experience in healthcare analytics or contracting or plan or provider operations required; other related experience may also be considered required
Demonstrated understanding of standard analytic methodologies and tools required
Excellent organizational, project management, and relationship management skills required
Excellent oral and written communications skills required
Excel, PowerPoint and Word skill preferred
Provider contracting or operations, a plus but not required preferred
We are committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our people and our business. We are an equal opportunity/affirmative action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law.
Depending on factors such as business unit requirements, the nature of the position, cost and applicable laws and regulations, EmblemHealth may provide work visa sponsorship for certain positions.