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Director, Contracting and Payor Relations, 100% Remote
We are currently working with a PE backed healthcare organization looking to add a Director, Contracting and Payor Relations to their team. This individual oversees a team of credentialing and payor contracting specialists to ensure that credentialing practices meet the needs of patients, facilities, payors, the market, state regulations and NCQA, Medicare/Medicaid, URAC, and/or Joint Commission credentialing standards.

The role is primarily responsible for creating and assisting with the development and implementation of supporting policies and procedures and workflows; handling payor contract management to maximize net operating margins and ensure market competitiveness; managing and monitoring the overall Credentialing Plan; evaluating the effectiveness of processes and procedures to support the plan; ensuring the organization is compliant with various credentialing requirements, as applicable; and maintaining payor rate sheet information and ensuring proper updates are distributed and/or uploaded.

Geography: 100% remote

MAJOR DUTIES AND RESPONSIBILITIES

• Establish and implement strategic goals to align with department and corporate goals and objectives
• Oversee the utilization and continuous improvement of the financial reports and analytics used for contract management
• Serve as the organization’s contact for payor contracting functions
• Support resolution of payor contractual issues pertaining to contract interpretation and coding with payors in conjunction with revenue cycle staff
• Assess payor contracting requirements and standards as they relate to industry/regulatory issues and market implications
• Recommend and implement necessary improvements and revisions to contracting requirements and standards
• Lead the development and testing of a contract pricing model and responsible for all activities related to the modeling of contract proposals that maximize net operating margins and ensure market competitiveness
• Ensure that payor fee schedules are updated on a regular basis and are uploaded/assigned in QDW appropriately
• Negotiate better payor fee schedule rates as the organization gains leverage through growth
• Evaluate and update internal UCRs on a regular basis to ensuring that billing practices are positioned for maximum revenue
• Evaluate charge integrity periodically by performing an analysis of charges and reimbursement for common procedures
• Manage and monitor the overall credentialing plan, operations, and needs for compliance. Make any necessary changes.
• Maintain up-to-date credentials for each licensed provider, including verification through primary and secondary sources, records, and relay credentialing information to relevant personal as needed
• Keep accurate records of provider licensure/ certification renewals
• Coordinate provider enrollments in all commercial, state, and federal insurance programs. Correspond with and provide updates to insurances.
• Partner with multi-functional team of business leaders on day-to-day operations
• Maintain knowledge of all state regulatory and accrediting body standards and maintain compliance
• Oversee and/or manage Delegated Agreements and all audit and reporting needs associated with each
• Participate in payor, state, and/or regulatory body interviews/presentations in discussions pertaining to credentialing
• Provide on-going opportunity and challenge for staff development
• Conduct regular meetings with direct reports and credentialing team to ensure that they are well informed of company goals and objectives, to set priorities, and to discuss progress towards goals
• Develop mechanisms for regular on-going feedback on areas of development and/or accomplishments
• Manage contracting and credentialing budget, as well as staffing needs

MINOR DUTIES AND RESPONSIBILITIES

• Participate in other revenue cycle meetings, as necessary
• Perform other duties as required or requested by leadership

PREFERRED QUALIFICATIONS

• Bachelor’s degree in a relevant subject
• 5-7 years of credentialing experience minimum
• Knowledge of credentialing software preferred
• Working knowledge of NCQA and URAC Credentialing Standards
• Ability to read, analyze and interpret general business periodicals, professional journals, technical procedures, government regulations, standardized instructions, short correspondence, and memos
• Must be able to review and make necessary revisions in credentialing delegation agreements with external payor partners
• 2+ years of supervisory experience

SKILLS AND ABILITIES

• Excellent attention to detail
• Self-directed, organizes and prioritizes work, and manages multiple tasks and assignments
• Ability to work independently within guidelines and company policies
• Manages time well and performs assigned duties with attention detail, accuracy, and follow-through with minimal supervision
• Strong analytical and problem-solving skills with ability to identify trends, define problems, develop solutions, and execute strategies
• Superior skills using Microsoft applications including Outlook, Teams, Word, Excel, and PowerPoint
• Ability to supervise, train, and transfer job knowledge to colleagues
• Strong verbal and written communication skills with ability to provide written communication/education to revenue cycle team members
• Excellent interpersonal skills and experience interacting with clinical and financial personnel in a fast-paced, multi-disciplinary, team environment
• Interacts with confidential information in a professional manner
• Must be able to make independent decisions

Director, Contracting and Payor Relations, 100% Remote
We are currently working with a PE backed healthcare organization looking to add a Director, Contracting and Payor Relations to their team. This individual oversees a team of credentialing and payor contracting specialists to ensure that credentialing practices meet the needs of patients, facilities, payors, the market, state regulations and NCQA, Medicare/Medicaid, URAC, and/or Joint Commission credentialing standards.

The role is primarily responsible for creating and assisting with the development and implementation of supporting policies and procedures and workflows; handling payor contract management to maximize net operating margins and ensure market competitiveness; managing and monitoring the overall Credentialing Plan; evaluating the effectiveness of processes and procedures to support the plan; ensuring the organization is compliant with various credentialing requirements, as applicable; and maintaining payor rate sheet information and ensuring proper updates are distributed and/or uploaded.

Geography: 100% remote

MAJOR DUTIES AND RESPONSIBILITIES

• Establish and implement strategic goals to align with department and corporate goals and objectives
• Oversee the utilization and continuous improvement of the financial reports and analytics used for contract management
• Serve as the organization’s contact for payor contracting functions
• Support resolution of payor contractual issues pertaining to contract interpretation and coding with payors in conjunction with revenue cycle staff
• Assess payor contracting requirements and standards as they relate to industry/regulatory issues and market implications
• Recommend and implement necessary improvements and revisions to contracting requirements and standards
• Lead the development and testing of a contract pricing model and responsible for all activities related to the modeling of contract proposals that maximize net operating margins and ensure market competitiveness
• Ensure that payor fee schedules are updated on a regular basis and are uploaded/assigned in QDW appropriately
• Negotiate better payor fee schedule rates as the organization gains leverage through growth
• Evaluate and update internal UCRs on a regular basis to ensuring that billing practices are positioned for maximum revenue
• Evaluate charge integrity periodically by performing an analysis of charges and reimbursement for common procedures
• Manage and monitor the overall credentialing plan, operations, and needs for compliance. Make any necessary changes.
• Maintain up-to-date credentials for each licensed provider, including verification through primary and secondary sources, records, and relay credentialing information to relevant personal as needed
• Keep accurate records of provider licensure/ certification renewals
• Coordinate provider enrollments in all commercial, state, and federal insurance programs. Correspond with and provide updates to insurances.
• Partner with multi-functional team of business leaders on day-to-day operations
• Maintain knowledge of all state regulatory and accrediting body standards and maintain compliance
• Oversee and/or manage Delegated Agreements and all audit and reporting needs associated with each
• Participate in payor, state, and/or regulatory body interviews/presentations in discussions pertaining to credentialing
• Provide on-going opportunity and challenge for staff development
• Conduct regular meetings with direct reports and credentialing team to ensure that they are well informed of company goals and objectives, to set priorities, and to discuss progress towards goals
• Develop mechanisms for regular on-going feedback on areas of development and/or accomplishments
• Manage contracting and credentialing budget, as well as staffing needs

MINOR DUTIES AND RESPONSIBILITIES

• Participate in other revenue cycle meetings, as necessary
• Perform other duties as required or requested by leadership

PREFERRED QUALIFICATIONS

• Bachelor’s degree in a relevant subject
• 5-7 years of credentialing experience minimum
• Knowledge of credentialing software preferred
• Working knowledge of NCQA and URAC Credentialing Standards
• Ability to read, analyze and interpret general business periodicals, professional journals, technical procedures, government regulations, standardized instructions, short correspondence, and memos
• Must be able to review and make necessary revisions in credentialing delegation agreements with external payor partners
• 2+ years of supervisory experience

SKILLS AND ABILITIES

• Excellent attention to detail
• Self-directed, organizes and prioritizes work, and manages multiple tasks and assignments
• Ability to work independently within guidelines and company policies
• Manages time well and performs assigned duties with attention detail, accuracy, and follow-through with minimal supervision
• Strong analytical and problem-solving skills with ability to identify trends, define problems, develop solutions, and execute strategies
• Superior skills using Microsoft applications including Outlook, Teams, Word, Excel, and PowerPoint
• Ability to supervise, train, and transfer job knowledge to colleagues
• Strong verbal and written communication skills with ability to provide written communication/education to revenue cycle team members
• Excellent interpersonal skills and experience interacting with clinical and financial personnel in a fast-paced, multi-disciplinary, team environment
• Interacts with confidential information in a professional manner
• Must be able to make independent decisions

IND123

Bachelors