Negotiates contracts and supports the, implementation and ongoing maintenance of IPA/Faculty Practice Plan (FPP) contracts, large medical group contracts, risk contracts, as well as other contracts that are entered into from time to time that have an impact on the delivery system as well as the overall plan financial position.
Each Contract Administrator is responsible for a minimum of 10 key groups with over 4000 clinicians.
Essential Duties: Negotiate and maintain contracts with IPAs/, large medical groups and hospital based Faculty Practice Plans on behalf of Emblem Health.
Manage contract relationship 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 implementations initiatives.
Establish and coordinate quarterly Joint Operating Committee meetings with key groups and senior Emblem leadership.
Resolve contract/claim disputes presented by key groups.
Investigate and respond to inquiries from Claims, Customer Service, Grievance and Appeals, and all other departments within Emblem.
Work closely with vendor managers to resolve key group disputes.
Identify trends within our systems and coordinate the corporate/interdepartmental steps necessary to correct root cause.
Participate in HCCI projects and assure successful implementation of corporate cost-saving initiatives to include reduction in contract rates, reduction in select fee schedules, tighter UM guidelines, etc. Recommend and implement innovative contracting strategies to maximize cost containment and innovative approaches to care, ie implementation of medical home.
Manage and implement various projects as assigned by the Director within the department.
Qualifications: Bachelors Degree in Health-Care or Business field.
Masters Degree a plus but not required.
Five years experience in Health Care Contracting.
Contract Administrator Job in New York, New York US