Summary of Position
- 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.
Principal Accountabilities
- 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 Education, Training, Licenses, Certifications
- B. S. degree in Business Operations, Information Systems or equivalent.
- Master's Degree a plus but not required.
Relevant Work Experience, Knowledge, Skills, and Abilities
- Minimum 2-3 years of relevant experience, preferably in a health care environment.
- Strong familiarity with EmblemHealth's claims systems and interdependent applications.
- Experience in provider, facility, and ancillary contract files set-ups, maintenance, testing and auditing functions.
- Experience in establishing and accomplishing business strategies to successfully translate contractual language into system
reimbursement specifications. - Excellent knowledge of medical terminology, Fee Schedules, and ICD/CPT/HCPCS coding.
- Understanding of Government reimbursement methodologies.
- Analytic, problem solver, excellent organizational and technical skills and attention to detail are required.
Additional Information
- Requisition ID: 1000002640
- Hiring Range: $48,600-$83,160
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EmblemHealth
Aug 20, 2025