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Contract Administrator

EmblemHealth New York Full-Time
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Administer and negotiate complex contracts, requiring extensive knowledge and experience in developing value based pay for performance and other contract specifications, contract monitoring procedures and ensuring the achievement of contract administration objectives.  The financial consequences of error could be significant, requiring independent judgment and initiative.  Manage assigned CHCs/FQHCs/D&TCs and Special Service Group (e.g. HouseCalls, Virtual Office Visits, Homeless, Mobile, etc.) and other provider Agreements, as needed.  Handle day to day operations/management, both internally and externally as the voice to assigned providers for all contractual, compliance (may include delegation oversight), regulatory, credentialing, provider file, report distribution and administrative policy and procedures.  Run work teams independently and manage projects to achieve specific objectives and participate in corporate work teams and projects as needed.  Accountable for print and online directory accuracy, appointment access and availability, RFI/RFP responses, HPN/HDS reporting, successful participation in QI programs, e.g. HEDIS/HCC/QARR/CHAPS/STARS, audits, and other similar activities for assigned providers.

Responsibilities:

  • Negotiate and maintain contracts with assigned providers on behalf of EmblemHealth.  
  • Develop new, effective contract supporting tools to drive medical cost reductions and support P4P initiatives.  
  • Develop value-based agreements using in-depth knowledge of Medicare reimbursement methodologies including PPS, fee schedule development using actuarial models and performance reports.  
  • Negotiate rates with providers utilizing financial models and analysis.
  • Manage contract relationships and chair bi-weekly/monthly meeting with key groups.
  • Assure full understanding of Emblem policies, educate providers on use of web portal/PEP, oversee credentialing delegation and all provider file related functions and rate implementation initiatives.  
  • Establish and coordinate quarterly Joint Operating Committee meetings with key groups and senior Emblem leadership.  
  • Provide advice, guidance and recommendations to management regarding health care costs, cost saving opportunities, best practices and provider performance issues.  
  • Communicate performance and compliance measures with Plan policies to groups in an effort to meet requirements.
  • Identify trends within company-wide systems and coordinate the corporate/interdepartmental steps necessary to correct root cause utilizing effective project management to ensure all deadlines are met.
  • Participate in HCCI projects and assure successful implementation of corporate cost-saving initiatives to include reduction in contract rates and tighter UM guidelines, etc.  
  • Recommend and implement innovative contracting strategies to maximize cost containment and improve quality of care, i.e. implementation of medical home.  
  • Implement programs to influence and change behavior of network providers in accordance with Emblem goals.
  • Manage and implement various projects as assigned by the Director within the Department.  
  • Maintain a continuing review of the progress of each large, complex contracts.  contract and provides management with information regarding any financial, legal or technical difficulties.  Coordinates contracting and management strategies with hospital and ancillary leads to ensure Emblem’s network strategy is comprehensive and does not conflict with other initiatives.  Prepares change order and amendments, negotiates with contractors and customers to obtain settlement.  May chair interdisciplinary work team(s).
Qualifications:

  • Bachelor’s Degree in Health Care or Business field
  • Master’s Degree a plus but not required (in lieu of experience)
  • Over 3-5 years’ experience in Health Care Contracting required
  • Organizational/Project Management skills required
  • Excellent oral and written communication skills required
  • Specialized courses or experience in pricing, contract law, negotiations and accounting required
  • Experience in developing contract types, fee arrangements, contract terms and value based arrangements required
  • Experience in developing and recommending potential solutions to contractual problems to management required
  • Proficiency in MS Word and Excel required
  • Knowledge of eSAWs, QCare, CPF and MCS systems a plus but not required preferred

Recommended skills

Scheduling
Credentialing
Management
Request For Proposal
Medicare
Finance
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EmblemHealth is
a local, neighborhood health plan that has served the New York City area and
surrounding communities for more than 75 years. That’s the kind of experience
that makes us unique. We’re proud to be one of the nation’s largest
not-for-profit health plans, serving 3.1 million people who live and work
across the New York tristate area.

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