Advantagecare Physicians New York , NY 10007
Posted 5 days ago
Summary of Position
We are seeking a dynamic Contract Specialist who will be responsible for loading all Professional, Facility, and Ancillary contracts across all EmblemHealth lines of business in a timely and accurate manner. This individual will provide subject matter expertise in all areas of contract configuration, fee schedules/groupers, and rate reimbursement. The Contract Specialist collaborates on workflows and business processes to ensure efficient interaction with Network Development, Analytics, and other business areas to facilitate accurate translation and maintenance of contractual agreements into the Network. This individual will also develop expertise in the downstream impact of loaded rates within EmblemHealth's full claims reimbursement cycle.
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 2-3 years of relevant experience, preferably in a healthcare environment 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
Analytic, problem solver, excellent organizational and technical skills and attention to detail are required
Additional Information
Advantagecare Physicians