Credentialing and Contract Manager

Credentialing And Contract Manager

As a key member of Advanced Pain Care's leadership team, the Credentialing and Contract Manager is responsible for the development, negotiation, and maintenance of all healthcare contracts as well as facilitating and managing the credentialing team. Key factors include assertively supporting the sales growth by developing new contracts with payers and expanding services with payers that have existing contracts. The position leads the entire contract process from pre-contract through post-signature phases, and closely collaborates with the sales team and internal departments to ensure staff are informed of new contracts, changes to existing contracts and updates to the medical and billing policies of the payers we serve.

Duties And Responsibilities

Develop, negotiate and maintain contracts with all payers, e.g., insurance companies, TPAs and government programs. This includes researching territories to identify gaps with our payer base and supporting the expansion into new markets and service lines.

Actively participate in establishing strategic business goals with the Leadership Team.

Assure contractual arrangements meet financial targets and legal/regulatory compliance requirements. There will be an emphasis on analyzing cost and utilization data.

Facilitate the approval process of all contract documents from pre-contract through post-signature phases.

Responsible for the accuracy of supporting documentation for contracts and completing documents accurately.

Develop and maintain processes that provide timely notification of critical contract events (e.g., renewals, termination and due dates contained within the agreements).

Maintain existing relationships with contracted providers. Ensure contractual language is kept current; evaluate fee schedule on a yearly basis to identify possible opportunities for additional covered services, medical policy changes and reimbursement.

Coordinate and communicate contractual terms to the billing department; ensure staff is informed of changes in medical policy & billing policies.

Conduct on-going assessments of assigned networks and make recommendations for strategic initiatives, goals and objectives.

Maintain ongoing report of the status of all contracts.

Assure accurate data entry of contract specifications and terms into established database and completeness of all contracting processes.

Maintain excellent written and verbal communication with all internal and external customers.

Effectively and professionally represent Advanced Pain Care to the provider community.

Assist with all contracting administration and projects, as needed.

Has regular and predictable attendance

Adheres to Advanced Pain Care's Policies and procedures

Performs other duties as assigned

Qualifications

Minimum of 3 years of relevant experience with hospital, clinic, ambulatory surgery center, physician, and/or primary care and health system contracting

Bachelor's Degree or equivalent experience

Strong demonstrated knowledge and understanding of healthcare industry, legal and regulatory requirements

Willingness to actively participate in all aspects of the contract administrative process. This is a hands-on working role as opposed to a lead and direct staff role.

Exceptional and proven provider partnership skills and interpersonal skills

Excellent contract negotiation skills

Ability to develop and deliver presentations to internal and external groups

Results driven, persistent - able to self-direct and work independently showing initiative, while seeking guidance when appropriate.

Ability to multi-task, pay close attention to detail and be flexible in a fast paced and growing organization

Strong organizational and analytical skills

Demonstrated strength in computer software, e.g., MS Office Suite, PowerPoint, social media and internet-based research.

Experience working at a medical insurance company, MSO, IPA, TPA highly preferred

Knowledge and use of Experian software preferred, but not required.

Working Conditions

Environmental Conditions: Medical Office environment

Physical Conditions:

Must be able to work as scheduled typically from 8:00 5:00 M-F

Must be able to sit and/or stand for prolonged periods of time

Must be able to bend, stoop and stretch

Must be able to lift and move boxes and other items weighing up to 30 pounds.

Requires eye-hand coordination and manual dexterity sufficient to operate office equipment, etc.