Description
Summary
The Contacting/Credentialing Specialist will play a key role in developing the Payor Relations function and processes and enrolling our behavioral and medical staff with a variety of health insurance payors.
They will reach out and work with payors to support the execution of provider contracts for ABA, Speech and Occupational therapy, Social Work, and other key services, leverage existing contracts to add new services and work to gain new contracts in new regions and States where ACP is growing. They will initiate credentialing with payors on behalf of ACP staff and follow up to complete the credentialing life cycle for our clinical staff.
Essential Functions
- Regular and reliable attendance is an essential function of this position.
- Organize credentialing documents from our growing network of providers, submit to payers, and follow up diligently to get to “in-network” status
- Work with payers to add new practice locations, provider rosters, and other administrative tasks to advance the objectives of ACP.
- Work with existing and new providers to create, update and maintain CAQH profiles and other necessary documents.
- Collaborate with Revenue Cycle to identify and resolve issues/concerns related to payors and network status.
- Help create, organize, and maintain contract management and credentialing databases including updating contracting and credentialing status, developing, and running reports for regional leadership, and tracking metrics for success for the contracting and credentialing function.
- Maintain ongoing tracking of activities on shared database for team collaboration.
- Communicate updates and status to stakeholders waiting to provide services via Teams and respond promptly to emails and calls to assist clinicians and other stakeholders with credentialing and contracting questions.
- Support the Payor Relations Director as needed in research, filing, follow-up, and organization documents for payor contracting.
- Support the Payor Relations Director as needed in follow-up with payors on contract, payment or other issues as well as audit activities (internal and external)
Competencies
- In-depth knowledge of CAQH, NPPES, NPDB
- Superior communication skills with ability to cultivate relationships externally with payers and internally with clinical providers and regional leadership.
- Proactive and capable of problem solving and working independently to meet deadlines
- Strong attention to detail and flexible and adaptable to changes
Work Environment
This position operates in an office environment.
Physical Demands
- Prolonged periods of sitting at a desk and working on a computer.
Education And Experience
- High school diploma or equivalent required.
- 2-3 years' experience in managed care contracting with public and private payers; behavioral health experience a plus. Experience with States in Northeast and Mid-Atlantic regions a plus.
Additional Requirements
- Employees in this role are considered essential workers as part of the critical infrastructure.
- No prior criminal history.
- Computer skills including Outlook, Excel, Word, PowerPoint
Disclaimer
Please note this job description is not designed to cover or contain an exhaustive list of all expectations, duties or responsibilities that are required of the employee for this job; employees may be required to perform additional functions. The company reserves the right to revise the job description at any time. The employee must be able to perform the essential functions of the position satisfactorily. If requested, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of their job, absent an undue hardship.
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