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. 

Provider Contract Specialist

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Program Management
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EmblemHealth
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Summary

Act as a liaison and operate as a vital link between specific Facility, Ancillary, Delegated and/or Professional providers and EmblemHealth.  Responsible for day-to-day operations for all activities related to contracts with minimal supervision and direction, contract optimization, implementation of new programs and to assist with provider issues, education materials, as well as communication of Plan policies and procedures.  Contact for all escalated issues from the Provider and internal EmblemHealth departments, including grievances, disputes, and provider/member billing complaints. 
Note: the term “Provider” can include managing entity for health systems, facilities such as a specialty office, large faculty and group practices, delegated relationships, ancillary or ambulatory centers and the like.

Responsibilities:

• Assist providers in all matters related to contract disputes and ensure accurate contract and rate load implementations are done in a timely manner. 
• Communicate with providers and respond to provider inquiries in a timely, accurate, and professional manner with minimal direction from leadership. 
• Support the timely completion/coordination of claim inquiries and complaints for the Hospital, Ancillary, and/or Professional network; coordinate Joint Operating Committees (JOCs), claim review and resolution and support of audits when needed. 
• Assist participating providers when issues require coordination of various Plan departments (Claims, Care Management, EDI, Grievance and Appeal, Customer Service, Enrollment, Special Investigations, Credentialing, etc.). 
• Provide timely, useful, and accurate responses to provider requests (provider requests for Plan materials; provider questions regarding fees, the Plan’s website and IVR; information in the Plan’s Provider Manual, and escalated claim inquiries. 
• Ensure and coordinate notification and education of various departments within the EH on contract terms and related issues and conditions. 
• Coordinate delegated credentialing functions and activities. 
• Ensure the accuracy of provider demographic data in the Plan’s database: review provider data for assigned Providers handle provider requests for demographic changes; research provider address discrepancies identified by provider returned mail and potential provider demographic errors identified by other Plan departments or initiatives.
•  May recruit available providers to fulfill Network deficiencies.
•  Perform outreach projects which may include requests by the Plan’s State Sponsored Programs Department for DOH, IPRO and DOI notices, HEDIS  medical record retrieval and other projects as needed.
• Document all outreach activities in compliance with department standards. 
• Perform additional duties as directed, assigned, or required.

Qualifications:
•    Bachelor’s degree in health care-related field, Public Administration, or Management
•    3 – 5+ years of direct provider relations experience required
•    Knowledge of provider and payor roles, responsibilities and challenges required
•    An understanding of health care financing, access issues, delivery systems, quality controls, and legislation required
•    Strong customer service skills and the ability to maintain an excellent rapport with providers and their staff required
•    Ability to work well with various Plan departments is instrumental in the effectiveness of the position required
•    Excellent communication skills, written and verbal, to ensure that the appropriate requests are articulated and that problems are accurately represented for resolution required
•    Time management skills and flexibility to work on multiple projects/assignments simultaneously, with ability to change focus in a crisis situation. Willingness to assume diverse duties and challenges required
•    Interpersonal skills to effectively maintain working relationships to get issues resolved or to obtain information through people, and to represent the Plan and the Department in a favorable light required
•    Ability to work independently assignments and maximize opportunities to support required 
•    Analytical and problem-solving skills to identify needs in provider relationships, make recommendations as projects develop and follow through to resolution using available resources to achieve a solution required
•    Proficiency testing in Excel, Word and other Microsoft applications required
•    PC skills including proficiency in Microsoft Office Suite required

Security Disclosure

If you are offered a job from one of the EmblemHealth family of companies that includes ConnectiCare, AdvantageCare Physicians, and WellSpark, the offer confirmation email will come from “HRTalentAcquisition” with the subject line: “Offer of Employment for (job title)” – Please respond online”.  

 

We never ask you to join a Google Hangout, request you to purchase your own equipment or pay to apply. We do not send email from a third-party email service such as Yahoo or Gmail. 

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.

EEOC Statement

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/gender, sexual orientation, gender identity or expression, pregnancy or related condition, marital status, national origin, disability, protected veteran status or any other characteristic protected by law.

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