Manager, Payer Contracting & Credentialing

at  Northpoint Recovery Holdings LLC

QUALIFICATIONS/REQUIREMENTS FOR POSITION:

• Bachelor’s degree in business administration, health management, or commensurate experience required
• Minimum of five (5) years of experience in managed care contracting and provider credentialing
• Minimum of three (3) years of hospital and/or payer negotiation and payer analysis experience
• Knowledge of fee for service and/or fee for value reimbursement method, delegated credentialing workflows, and working knowledge of all major payers
• Strong at synthesizing information; easily distill easy-to-understand takeaways and next steps, diagnose problems, see patterns, and come up with targeted solutions
• Self-Starter; organize processes, improve workflows that already exist, and continuously strive for more efficiency
• Impeccable attention to detail; able to catch areas of opportunity in data or workflows quickly and document processes in a concise but thorough manner
• Must work well under pressure, able to focus on multiple priorities while maintaining focus, attention to detail and connecting all the dots
• Proficiency with Microsoft Office Suite

PREFERRED KNOWLEDGE AND SKILLS:

• Knowledge of behavioral health care HCPCS/CPT coding
• Business acumen and strong financial skills
• Able to maintain confidentiality of sensitive information
• Excellent communication skills: ability to communicate clearly and concisely, verbally and in writing
• Strong interpersonal skills to handle sensitive situations and confidential information
• Social ease and a demonstrated ability to build relationships with a variety of different people and personality types
• Ability to perform several tasks concurrently with ease and professionalism
• Ability to effectively prioritize workload in a fast-paced environment

ABILITY TO COMMUTE/RELOCATE:

• Meridian, Idaho; reliably commute or plan to relocate before starting work (Required)
  This job description is not intended, and should not be construed, to be exhaustive lists of all responsibilities, skills, efforts or working conditions associated with this job. It is meant to be an accurate reflection of the principal job elements essential for making fair pay decisions about jobs.
  Employees with potential access to protected health information must comply with all procedures and guidelines governed by HIPAA.
  Northpoint is an Equal Opportunity Employer. Northpoint is an At-Will employer. Employment may be terminated at any time by the employee, or employer with or without notice

ESSENTIAL RESPONSIBILITIES AND DUTIES INCLUDE BUT ARE NOT LIMITED TO THE FOLLOWING:

• Responsible for technical and facility base payer contracting, credentialing, and pricing for Northpoint
• Responsible for the overall management of all in-network and out-of-network contracting and negotiations for the organization and employed provider
• Build an effective multi-state licensing and credentialing strategy and process that can scale nationally, coordinating between providers, medical boards, payers and government agencies
• Coordinate with clinical operations, licensing agencies, insurance carriers, and other appropriate organizations to complete credentialing and recredentialing applications
• Maintain a database for licensing, contracting and credentialing and continues to develop new processes and procedures; ensuring full utilization of systems and platforms
• Monitor entity-specific rules, policies, and procedures, ensuring compliance with accrediting organization and payer requirements; develops, recommends and/or implements changes, revisions and enhancements as appropriate to the current operating environment
• Effectively communicating on detailed and complex topics, such as healthcare industry specifics, market dynamics, trends, regulations and payer environment
• Perform full life-cycle contract management for a large portfolio of high value contracts
• Provide technical expertise in developing, organizing, and processing contracts and facilitate the approval process of all contract documents from pre-contract through post signature phase
• Facilitate operationalizing payer contract requirements with cross-functional teams. Works with the broader team to ensure steps or protocols are in place based on payer contract language
• Pursue regular rate increases with contracted payers
• Evaluate and monitor contract performance to determine necessity for amendments, updates, or extensions of contracts, and compliance to contractual obligations
• Audit charge master in billing software system and update to reflect annual COLAs and rate increases as needed
• Provide RCM team with applicable payer updates to policy manuals, medical necessity guidelines, as needed
• Ensure contracts have correct HCPCS/CPT codes for services offered
• Pursue professional services/specialty medication coverage contracts
• Adhere to all company policies and procedures
• Maintain confidentiality in accordance with established policies and procedures and standards of care
• Performs other related duties and special projects as assigned

SUPERVISORY RESPONSIBILITIES:

• Direct supervisor for contracting and credentialing staff

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Job performed at a desk in front of a computer.
• Requires heavy use of mouse and keyboard.
• Indoor office environment
• Though this position is not permanently located in a treatment facility setting, exposure to emotionally impaired patients is possible, and may be frequent. Stress ranges from low to high, depending on the situation