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.
Sr. Vendor Specialist
Summary of Position:
Accountable for the oversight and management of one or more specific Payment Integrity vendor contracts. Lead day to day operations for all activities related to one or more specific vendor contracts, contract optimization, implementation of new programs and business ownership of all EPMO and IT projects associated with vendor contract(s).
Responsibilities:
- Responsible for specific contracts in Enterprise Payment Integrity.
- Serve as a primary subject matter expert for each contract to ensure optimal contract management and outcomes.
- Act as a point of communication and coordination with all internal business units for all issues related to vendor contracts.
- Responsible for “end to end” contract management which includes performing all pre-contractual and implementation activities, business ownership of EPMO and IT projects, development of contract performance standards and associated penalties, root cause analysis and ongoing monitoring and oversight.
- Actively participate in all related Policy Meetings, Quarterly Business Reviews, Reimbursement Policy Committees, Steering Committees.
- Create monthly savings reports and identify and address trends in comparison to established goals.
- Complete monthly invoices and reconcile against Oracle system reporting.
- Identify system enhancements and process improvements which will result in enhanced reporting and savings.
- Apply project management skills to complete related projects and assignments.
- Identify and recommend new programs, savings opportunities, and ways to optimize current contracts.
- Engage vendors and internal business units to review opportunities and lead business case development, savings opportunity analysis, and creation of EPMO or IT related projects.
Qualifications:
- Bachelor’s degree
- AAPC CPC (AAPC Certified Professional Coder) &/or CCS (AHIMA Certified Coding Specialist)
- Master’s Degree preferred
- 3 - 5+ years or relevant, professional experience in health care contracting and management required
- Additional experience/specialized training/certifications may be considered in lieu of bachelor’s degree requirements required
- Strong understanding of the healthcare industry, managed care and health plan operations required
- Experience in managing large, complex contracts required
- Experience with performance improvement required
- Excellent organizational, prioritizing, and project management skills; ability to manage multiple/complex projects required
- Proficiency in MS Office (Word, Excel, PowerPoint, Access, Outlook) required
- Knowledge of claims operating platforms required
- Effective communication skills (verbal/written/presentation/interpersonal) with all types/levels of audience 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.