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Manager & Professional
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EmblemHealth
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The Manager will plan, organize and direct all aspects of the functions to ensure timely, legally compliant and accurate billing while maximizing the cash flow related to the collections of Accounts Receivables for Large Groups through monthly reconciliations. Ensure the members have access to care.  Provide World Class Service to our clients.  This position interfaces heavily with external clients, Account Management,  Finance and the Enrollment & Billing Vendors.

Responsibilities:
  • Supervise a team responsible for the enrollment and payment reconciliation of the largest Emblem clients (e.g. Fed, NY State, NY City) to Identify discrepancies and drive for resolution.  Leveraging technology, the team of data analysts will perform systemic compares of the client’s membership file supporting their payment to Emblem’s membership membership records.  The team will identify members that are active with Emblem Health but not included in the client’s payment; on the Clients Records but not active with Emblem Health; benefit; contract type and other discrepancies  would be noted and need to be resolved.
  • Partner with Account Management to communicate with the clients on discrepancies / trends and with Finance to align on objectives for revenue cycle management. Work with all internal customers to establish competency.  Identify Have a clear understanding of the EDI process,  providing direction/suggestions to the clients and vendors to ensure smooth processing of the enrollment.
  • Act as a liaison between Emblem Health, the Clients (NYS, City  and Feds) and vendor for enrollment processing   Identify members that the vendor missed when processing terminations or adds.from the EDI File.
  • Monitor timely and accurate payments from the clients, track Accounts Receivable balances and develop, implement and maintain collection policies, procedures and processes with appropriate controls and checks and balances.  Follow-up with Account Management/Client on outstanding reconciling items that remain unresolved.  Provide recommendations with data points to Sr. Leadership on next steps for outstanding accounts receivable balances.
  • Champion, coordinate and implement process and technical  improvements for the EDI enrollment exchanges.



Qualifications:
  • Bachelor’s Degree
  • 5-8 years of experience
  • Experience training and troubleshooting within health care and managed care business specialty area in finance,  and office management, preferred
  • Commercial Healthcare experience a+
  • Self-starter with strong problem solving acumen with critical thinking and analytical skills
  • Background in 834 EDI Processing
  • Proficiency in Microsoft Office, Excel, Access  and Data Analytics
  • Supervisory experience

Company Statement

Careers at EmblemHealth: For nine decades, EmblemHealth has been making quality health care accessible and affordable for New Yorkers, and helping to make life better in the communities we serve. Our employees are proud of that legacy and want to make health care better for everyone. Here we inspire success while helping employees build meaningful careers. We offer competitive health and welfare benefits, retirement benefits, and incentive pay plans. Join us for a rewarding experience.

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, national origin, disability, protected veteran status or any other characteristic protected by law.

Sponsorship Statement

Depending on factors such as business unit requirements, the nature of the position, cost and applicable laws and regulations, Emblemhealth may provide work visa sponsorship for certain positions.

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Bridgete Nunes referred the Physician - Albany position. Apr 29, 2024
Mohammed Raian referred the Physician - Albany position. Apr 23, 2024
Mohammed Raian referred the Physician - Albany position. Apr 09, 2024
Mohammed Raian referred the Physician - Albany position. Apr 09, 2024
Someone applied to the Value-Based Network Manager position. Aug 29, 2023

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