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Title

Payor Contracting and Credentialing Manager  

Salary  
Full-Time/Part-Time Full-Time  
Shift -not applicable-  
Location Boundless- Worthington Campus  
Position Payor Contracting and Credentialing Manager  
Category Administration  
Exempt/Non-Exempt Exempt  
Open Date 2/4/2021  
Close Date 3/6/2021  
Req Number ADM-21-00002  
Description

I Am Boundless, Inc. is seeking an energetic and experienced Payor Contracting and Credentialing Manager who has a passion for helping others and wants the opportunity to work alongside some truly exceptional people.

What We Offer
Working for Boundless has many perks. Members of the Boundless team enjoy robust benefits including generous paid time off, health insurance, and more. We offer advantages that allow you to focus, thrive, and grow. Looking to develop your skills? Boundless can offer you hard to find training, along with personal and professional growth opportunities.

What You Will Be Doing
The Payor Contracting & Credentialing Manager ensures that practitioners (physicians, podiatrists, dentists and psychologists, and allied practitioners) are credentialed correctly to comply with applicable professional and regulatory requirements. The Payor Contracting & Credentialing Manager is responsible for managing the credentialing and re-credentialing process, including supporting credentialing meetings. The Payor Contracting & Credentialing Manager will be responsible for managing our payor contracts and establishing and coordinating the negotiation of the terms and fees applicable to those contracts. The Payor Contracting & Credentialing Manager works with the Legal Department Director of Compliance to ensure compliance with federal laws, rules, and regulations pertaining to Medicare and Medicaid programs. This position manages new applications for and maintaining all organizational licenses, certifications, and registrations to ensure compliant business operations.

The Payor Contracting & Credentialing Manager is responsible for managing the credentialing process and managing all payor contracts. This position is also responsible for developing credentialing policies and procedures, ensuring that the policies have been reviewed for legal compliance, working collaboratively with our Services Agreement partners and provider credentialing communications, and oversight of Physician and/or Allied Practitioner proctoring requirements per policy.

Essential Functions
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

  • Monitor, maintain, and coordinate reviews and updates to all payor contracts for behavioral health and medical services.
  • Prepares credentialing reports for internal and external customers both monthly and as needed.
  • Manage the credentialing processes with new payors as needed.
  • Utilize the organization’s revenue cycle management dashboards and analytics capabilities to analyze various payors and specific plans compared to cost of services delivered, utilization rates, collection rates, timeliness of payment, and other relevant considerations to make recommendations regarding ongoing contracting and network participation decisions.
  • Educate billing and clinical teams on the contracts' terms, including any value-based, outcomes-based, or alternative payment terms of contracts.
  • Collaborate with the health information & analytics department on identifying mechanisms for tracking and reporting all new monitoring elements or reporting elements needed for each payor and contract.
  • Collaborate with the finance, legal, compliance, and other departments, as needed, to perform required functions, which result in the negotiation of the executed contracts as needed.
  • Build and maintain collaborative relationships with provider representatives for each payor, emphasizing major payor partners, including Medicaid Managed Care Plans.
  • Complete initial credentialing of the behavioral health and medical services professionals as they onboard and make updates or ongoing changes, as needed.
  • Submit credentialing rosters to the centralized credentialing system(s) or payors MITS monthly according to the intervals required per payor or payor type.
  • Keep credentialing rosters up to date as employees resign or transition.
  • Key role in billing compliance by auditing quarterly samples, reviewing data weekly, looking at outliers, educating the team on finding and assisting with corrective plans when needed, with a special emphasis on contract compliance and clean submission rates in accordance with each payors billing rules.
  • Research new service lines under consideration in alignment with the organization’s growth and strategic plan as it pertains to various payors and provides summaries of rates, models, and billing requirements for use in strategic planning and new service delivery implementations.
  • Stay updated on all policy changes, billing requirements, and payor specific guidance for each payor, analyze the company's impact and communicate all changes to the necessary departments.
  • Maintains a working knowledge of licensing and credentialing requirements at the local, state, and federal levels.
  • Tracks and maintains all required clinical licenses.
  • Tracks licensing requirements and regulations that affect the organization's policies and recommends changes to Director, Revenue and Reimbursement.
  • Coordinates with applicable Boundless departments to complete all government, regulatory, and compliance documents on an enterprise-level related to the acquisition and maintenance of required licenses and certificates from appropriate state and federal entities.
  • Comply with HIPAA and the Boundless compliance program policies and other applicable organization and departmental policies.
  • Maintain privacy and confidentiality at all times.
  • Performs other duties as assigned.
 
Position Requirements

Required Education and Experience

  • Bachelor’s degree in business, healthcare, or related field.
  • Minimum of three (3) years for related payor contract management and credentialing experience.
  • Proficient in CAQH, NPDB, NPPES, and other credentialing resources.

Preferred Education and Experience

  • Post Graduate degree.
  • Strong technical acumen and can successfully translate operational needs into technical capabilities.
  • Healthcare industry experience.
  • FQHC experience a plus.

At Boundless, we are building a world that realizes the potential of all people. Will you join us? Apply today.

All candidates who have received an offer of employment will be required to undergo a pre-employment background check, drug screen, and health screen as applicable for the role.

We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, disability status, protected veteran status, or any other characteristic protected by law.

 
EOE Statement We are an equal employment opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, disability status, protected veteran status or any other characteristic protected by law.  

This position is currently not accepting applications.

To search for an open position, please go to http://IAmBoundlessInc.appone.com



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