Summary of Position

Responsible for timely and accurate load of all Professional, Facility, and Ancillary contracts across all EmblemHealth lines of business. Serve as a subject matter expert in all areas of contract configuration, fee schedules/groupers, and rate reimbursement. Develop 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 NetworX. Serve as the subject matter expert in NetworX.

Responsibilities:

Responsible for all aspects of provider, facility, and ancillary rate configurations within NetworX in accordance with 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. Responsible for the identification and correction of rate load problems.  Serve as a subject matter expert with all contract configuration, fee schedule / grouper, and rate reimbursement matters. Analyze negotiated contracts to determine NetworX interaction with the core systems, ensuring that reimbursement is in line with negotiated intent. Coordinate with Network Management to ensure timely update of all evergreen contracts. Recommend contract language changes to align with system reimbursement capabilities. Coordinate with all EmblemHeatlh towers on related NetworX issues. 

Qualifications:

B. S. degree in Business Operations, Information Systems or related field 3 – 5+ years of relevant experience, preferably in a health care environment required Additional experience or specialized training may be considered in lieu of educational requirements Strong familiarity with EmblemHealth’s 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 Strong attention to detail; strong organizational, analytic, technical, and problem‐solving skills required Proficient with MS Office (Word, Excel, PowerPoint, Outlook, Teams, SharePoint, etc.) required Strong communication skills (verbal, written, presentation, interpersonal) with all types/levels of audiences required Additional Information Requisition ID: 2405C Hiring Range: $51,900 - $80,000