Ancillary Contracting Specialist

📁
Manager & Professional
💼
EmblemHealth
Sign Up for Job Alerts

Under general direction, maintains contractual and service relationships between the Plan and Delegated entities including over 1500 statewide ancillary providers in accordance with budget and network development goals and initiatives.

Responsibilities:

  • Manages providers in all matters related to contract disputes and ensures accurate contract and rate load implementations.  Communicates independently with providers and responds to provider inquiries in a timely, accurate, and professional manner.  Manages complaints submitted via ESAWS for delegated entities.
  • Directly maintains terms of agreements both rates and language.
  • Obtains documentation for credentialing and collects data pertaining NY State Health Provider Network (HPN) reporting. Includes management of  IPA dataset submissions.
  • Develops detailed financial models ensuring accurate and appropriate decision making data for contract   negotiations.  Authors, edits, and drafts strategic reports and analyses.
  • Identifies contracting opportunities and needs within the network based on quality, access, and financial metrics.  
  • Ensures and coordinates notification and education of various departments within the Plan on contract terms and related claims issues and conditions.  Facilitates facility and professional claim recycles/adjustments with delegated entities.
  • Assists in the recommendation of innovative contracting strategies to maximize cost containment, access and quality through provider arrangements; remains current on provider reimbursement methodologies, and identifies provider reimbursement trends to assist in the development of provider contracting strategies
  • Assists in the development of materials necessary for provider education, orientation and training.

Requirements:

  • Bachelor’s degree in Health Care related field, Public Administration, Finance, or Management
  • Masters or CPA preferred
  • Minimum of 3 – 5 years healthcare contracting related experience (R)
  • Strong provider negotiating and contracting experience will be considered in lieu of a four-year degree (R)
  • Minimum one year of financial analysis and contract modeling (R)
  • Knowledge of provider contracting methodology and payor roles, responsibilities and challenges (R)
  • Understanding of health care financing, access issues, delivery systems, quality controls, and related healthcare legislation (R)

Previous Job Searches

Similar Listings

EmblemHealth

New York, New York

📁 Manager & Professional

EmblemHealth

New York, New York

📁 Manager & Professional

EmblemHealth

New York, New York

📁 Manager & Professional