Company Statement

Connecticare is a leading health plan in the state of Connecticut and a subsidiary of EmblemHealth, a health and wellness company that provides insurance plans, primary and specialty care, and wellness solutions.  WellSpark is a digital wellness company and national subsidiary of EmblemHealth that offers a full suite of products and solutions to reward people for healthy behaviors.

 

To protect the health and safety of our workforce, members, patients, and the communities we serve, the EmblemHealth family of companies require all new employees to be fully vaccinated for COVID-19. Exemption/reasonable accommodations may be granted because of 1) a qualifying medical condition or disability that makes getting the vaccine unsafe for the individual, or 2) objection on the basis of sincerely held religious beliefs and/or practices.
 

Contract Specialist

📁
Operations
💼
EmblemHealth
Sign Up for Job Alerts
  • Load all Professional, Facility, and Ancillary contracts across all EmblemHealth lines of business in a timely and accurate manner.  
  • Provide subject matter expertise in all areas of contract configuration, fee schedules/groupers, and rate reimbursement.
  • Collaborate 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 Network.   
  • Develop expertise in the downstream impact of loaded rates within EmblemHealth’s full claims reimbursement cycle.  

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.

Requirements:

  • B. S. degree in Business Operations, Information Systems or equivalent required; Master’s Degree a plus; equivalent experience and specialized certifications/trainings may be considered in lieu of the education requirement
  • Minimum 2-3 years of relevant experience required, preferably in a health care environment
  • Strong familiarity with 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 required

Pay Disclosure

A good faith estimate of the compensation range for individuals hired to work for the EmblemHealth Family of Companies is provided. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate’s work experience, education/training, internal peer equity, and market and business considerations. The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. It is not typical for an individual to be hired at or near the top of the range, as compensation decisions depend on each case’s facts and circumstances. Union roles covered by a collective bargaining agreement will compensate in accordance with the union contract.

Previous Job Searches

Similar Listings

EmblemHealth

New York, New York

📁 Operations