Sr. Value Based Contracting Specialist_Scot
- 📁
- Manager & Professional
- 💼
- EmblemHealth
- 📅
- Sep 28, 2023 Post Date
Summary
Build, optimize and enhance our value-based provider networks through relationship development with key local network participants. “Provider” can include managing entity for health systems, independent practice associations, large faculty and group practices, delegated relationships, ancillary or ambulatory centers and the like. Act as a liaison and operate as a vital link between specific Facility, Ancillary, Delegated and/or Professional providers and EmblemHealth. Develop provider contracting efforts, including but not limited to process oversight, strategic diligence, outreach, and contract negotiations. Responsible for day to day operations for all activities related to contracts, contract optimization, implementation of new programs and to assist with provider issues, education materials, as well as communication of Plan policies and procedures.
Responsibilities:
- Recommend innovative contracting strategies to maximize value, cost containment, access and quality through provider arrangements.
- Negotiate and communicate contract terms, payment structures, and reimbursement rates and value-based incentive programs to providers.
- Remain current on provider reimbursement methodologies, value-based models, and identify provider reimbursement trends to assist in the development of provider contracting strategies.
- Ensure accurate contract, provider, and rate load implementations are done in a timely manner.
- Communicate independently with providers and respond to provider inquiries in a timely, accurate, and professional manner.
- Responsible for ongoing network participation and performance, including performance analytics and management, as well as contract renewals and terminations.
- Analyze financial impact of contracts and terms, project value-based contract surplus or deficits, and maintain associated financial reporting tools.
- Responsible for the accuracy of all documentation in support of contracts.
- Provide timely, useful, and accurate responses to provider requests. This includes but is not limited to provider requests for Plan materials, and provider questions regarding fees, the Plan’s website and IVR, information in the Plan’s Provider Manual, and escalated claim inquiries.
- Optimize interactions with assigned providers and internal business partners to establish and maintain productive, professional relationships.
- Ensure and coordinate notification and education of various departments within the EH on contract terms and related issues and conditions; coordinate delegated credentialing functions and activities.
- Ensure the accuracy of provider demographic data in the Plan’s database. This includes but is not limited to reviewing provider data for assigned Providers, handling provider requests for demographic changes, researching provider address discrepancies identified by provider returned mail and potential provider demographic errors identified by other Plan departments or initiatives.
- May recruit available providers to fulfill Network deficiencies.
- Perform outreach projects which may include requests by the Plan’s State Sponsored Programs Department for DOH, IPRO and DOI notices, HEDIS medical record retrieval and other projects as needed. All outreach documented in compliance with department standards.
- Perform additional duties as directed or required.
Qualifications:
- Bachelors’ degree in Health Care-related field, Public Administration, or Management
- 3 – 5 years of direct provider relations, contracting, and value-based payment model experience (R)
- Knowledge of provider and payor roles, responsibilities, and challenges. An understanding of health care financing, access issues, delivery systems, quality controls, and legislation (R)
- Strong customer service skills and the ability to maintain an excellent rapport with providers and their staff (R)
- Ability to work well with various Plan departments is instrumental in the effectiveness of the position (R)
- Excellent communication skills, written and verbal, to ensure that the appropriate requests are articulated and that problems are accurately represented for resolution (R)
- Time management skills and flexibility to work on multiple projects/assignments simultaneously, with ability to change focus in a crisis situation. Willingness to assume diverse duties and challenges (R)
- Interpersonal skills to effectively maintain working relationships to get issues resolved or to obtain information through people, and to represent the Plan and the Department in a favorable light (R)
- Ability to work independently assignments and maximize opportunities to support (R)
- Analytical and problem-solving skills to identify needs in provider relationships, make recommendations as projects develop and follow through to resolution using available resources to achieve a solution (R)
- PC skills including proficiency in Microsoft Office Suite (R)
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.
