Elderwoodposted 7 months ago
$64,480 - $97,760/Yr
Full-time - Mid Level
Hybrid - Buffalo, NY
Nursing and Residential Care Facilities

About the position

Elderwood Independent Practice Association (IPA) is seeking a Senior Contracting and Credentialing Manager to join our incredible growing team of professionals. This position is crucial for the management of the contracting process with providers and health plans, ensuring that all agreements are executed efficiently and effectively. The Senior Contracting and Credentialing Manager will be responsible for engaging new contracts, managing the entire contracting process from initial engagement to finalizing contract language and rate setting, and participating in negotiations. This role requires a comprehensive understanding of provider contracts and the ability to coordinate with legal and other internal stakeholders to manage the review of new contracts and amendments. In addition to overseeing the signature and countersignature process, the Senior Contracting and Credentialing Manager will be responsible for organizing and storing fully executed agreements and contract documents in the contract management system. The role involves interfacing with various departments to develop contractual proposals and evaluating scenarios using data analysis and industry knowledge. The manager will present sound recommendations to senior leadership regarding contracting and negotiating with providers, collaborating with key staff to resolve operational issues and assist with process improvement. The position also entails developing and maintaining reimbursement tools, creating contract status summaries, and coordinating external reporting to contracted health plans. The manager will oversee the credentialing database, ensuring data accuracy and monitoring critical data for analysis and report generation. Additionally, the role includes managing the expirables process to ensure all provider licenses and certificates remain current and monitoring turnaround times for credentialing applications. The Senior Contracting and Credentialing Manager will drive the implementation of protocols for gathering credentialing data and oversee the presentation of provider files to the Credentialing Committee, ensuring that all processes are completed in a timely manner.

Responsibilities

  • Seek opportunities to engage new contracts for Elderwood IPA and partnered health plans.
  • Manage entire contracting process from initially engaging providers to finalizing contract language and rate setting.
  • Participate in negotiation process.
  • Conduct business review of provider contracts and coordinate with legal and other internal stakeholders to manage comprehensive review of new contracts and amendments.
  • Oversee signature and countersignature contract process.
  • Organize and store fully executed agreements and contract documents for each provider in contract management system.
  • Interface with various departments in developing contractual proposals.
  • Evaluate scenarios using data analysis, industry knowledge, and information from internal stakeholders.
  • Present sound recommendations to senior leadership related to contracting and negotiating with providers.
  • Collaborate with other key Elderwood IPA staff to resolve operational issues and assist with process improvement.
  • Develop and maintain reimbursement tools for organizational use.
  • Create and maintain contract status summaries and tools to keep senior leadership apprised of status.
  • Coordinate and complete external reporting to contracted health plans, including credentialing and various required reports and submissions.
  • Coordinate the management of the credentialing database and associated modules, ensuring accuracy of data and reporting.
  • Monitor critical data for extensive analysis and report generation.
  • Coordinate the management of the expirables process to ensure all provider licenses and certificates remain current.
  • Monitor and report on turnaround times for processing of credentialing applications.
  • Drive and implement seamless protocols for gathering credentialing data from providers.
  • Define and implement processes to ensure credentialing is completed and up to date in a timely manner.
  • Oversee the presentation of provider files to Credentialing Committee.
  • Oversee the provider monthly monitoring process.

Requirements

  • Bachelor's Degree required.
  • Minimum five to seven years' experience in provider or health plan setting.
  • Experience in one or more of the following: credentialing, reimbursement, contract review, or data analysis.
  • Critical thinking and analytical skills required.
  • Familiarity with industry standard reimbursement methodologies, including Medicare, Medicaid, and other third-party commercial reimbursement.
  • Strong interpersonal and communication skills necessary to effectively work with providers and payers.
  • Proficiency in Microsoft Word, Excel, Outlook as well as web-based research preferred.
  • Ability to read, write, speak, and understand the English language at an intermediate or more advanced level.

Nice-to-haves

  • Experience in a healthcare setting is preferred.
  • Knowledge of federal and state laws as they relate to payer payment structures.

Benefits

  • Monday-Friday Schedule with no weekends or overnights.
  • Hybrid working options.
  • Medical, Dental & Vision upon 1st of month following 60 days of hire.
  • Up to 140 hours (19 days) of PTO time PLUS six (6) holidays within the 1st year.
  • 401(k) retirement plan with vested employer match up to 4%.
  • Substantial Referral program.
© 2024 Teal Labs, Inc
Privacy PolicyTerms of Service