Contracting and Credentialing Specialist
Location
Eden Prairie, MN | United States
Job description
Lakeside HR Group has been engaged by our client to recruit a Contracting and Credentialing Specialist.
Our client is a leading provider of behavioral health billing and revenue cycle management (RCM) services and practice management software. What sets them apart is their relational approach to billing, where they not only focus on thes in billing is driven by excellent service. Their dedicated team supports therapists and administrators in handling all aspects of billing, from mundane day-to-day tasks to complex denials and appeals. Their service portfolio includes revenue cycle management, credentialing and contracting assistance, and practice management software. They provide therapists with the necessary data and support to make informed decisions and remain focused on their practice.
Job Summary: As a Contracting and Credentialing Specialist, focused on Behavioral Health you will play a vital role in ensuring the effective management of contracts and agreements related to behavioral health services for multiple customers. Your primary responsibility will be to work with individuals and groups with insurance carriers as well as analyze and apply for contract participation for their behavioral health customers. Your expertise in behavioral health services contracting and credentialing will be instrumental in supporting the organization's mission of providing high-quality care to our customers.
Key Responsibilities:
Contract Management:
- Oversee the implementation and execution of insurance contracts.
- Maintain accurate and up-to-date contract records, including amendments, extensions, and terminations.
- Establish and maintain strong relationships with contract partners, addressing concerns, facilitating communication, and resolving disputes in a timely manner.
Provider Credentialing:
- Oversee the credentialing process for behavioral health providers.
- Ensure providers meet the credentialing requirements of various regulatory bodies, accrediting organizations, and payers.
- Coordinate the collection, verification, and maintenance of provider credentials, including licenses, certifications, education, and training.
- Facilitate the enrollment and revalidation processes with insurance plans and payers.
Contract and Credentialing Compliance:
- Monitor and maintain compliance with contractual obligations, regulatory requirements, and quality standards.
- Keep up-to-date with industry changes and regulatory updates related to contracting and credentialing, and implement necessary changes to policies and processes.
Provider Network Management:
- Develop and maintain strong relationships with healthcare payers, ensuring effective communication and negotiation for network participation, contract renewals, and modifications.
Regulatory Compliance:
- Stay updated on federal, state, and local regulations pertaining to behavioral health services and contracts, ensuring adherence to all relevant laws and guidelines.
Stakeholder Collaboration:
- Engage in effective communication with external stakeholders, including healthcare providers, payers, and vendors, to foster positive relationships and resolve issues.
Qualifications:
- Bachelor's degree in business administration, healthcare administration, or a related field.
- Proven experience in medical contracting and credentialing, preferably within a behavioral health organization or medical billing company.
- Understanding of behavioral health services, including treatment modalities, reimbursement models, and regulatory requirements.
- Knowledge of healthcare contracting principles, payer reimbursement methodologies, and regulatory requirements.
- Knowledge of healthcare credentialing software (i.e. PECOS, MCC, CAQH).
- Familiarity with credentialing processes, standards, and guidelines (e.g., NCQA, JCAHO).
- Knowledge of relevant legal and regulatory frameworks governing healthcare contracts (e.g., HIPAA, Stark Law).
- Medicare credentialing and contracting a must.
- Strong interpersonal and communication skills.
- Detail-oriented with exceptional organizational and time management abilities.
- Ability to work independently and collaboratively in a fast-paced, deadline-driven environment.
- Fully remote position, preferably in Minnesota.
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