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Provider Contract Specialist
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- Act as a liaison and operate as a vital link between specific Facility, Ancillary, Delegated and/or Professional providers and EmblemHealth.
- Note: the term “Provider” can include managing entity for health systems, facilities such as a specialty office, large faculty and group practices, delegated relationships, ancillary or ambulatory centers and the like.
- Assist participating providers when issues require coordination of various Plan departments (Claims, Care Management, EDI, Grievance and Appeal, Customer Service, Enrollment, Special Investigations, Credentialing, etc
- Provide timely, useful, and accurate responses to provider requests (provider requests for Plan materials; provider questions regarding fees, the Plan’s website and IVR; information in the Plan’s Provider Manual, and escalated claim inquiries.
- 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.
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