Prestige Utilization Management & Billing Solutions, LLC Facility Contracting Specialist Remote · Full time

Facility Contracting for commercial and medicaid insurance carriers.

Description

Job Summary


The Facility Contracting Coordinator helps accomplish company goals by ensuring that facilities are contracted with requested insurance carriers and that individual providers that we work with are appropriately credentialed. The ideal candidate is ambitious. Has passion and drive, integrity, great attention to detail, professionalism, and excellent organizational skills to accomplish department goals.

The position requires knowledge of the substance abuse and mental health care industry and an effective strategy for working with insurance carriers to ensure our doctors and institutions are credentialed appropriately. This role will ensure timely and accurate enrollment of providers to insurance panels and monitor their credentialing status to remain compliant.


Department: Contracting

Supervisor: Contracting Supervisor

Supervisees: None

Employment Status: Full Time (40-50 hours a week)

Exemption Status: Exempt W-2

Work Environment: Remote



Job Responsibilities & Qualifications


  • Compliance: Adheres to all policies and procedures as outlined in the employee handbook. Understands and complies with all HIPAA rules and regulations. Keep up to date with department policies and procedures and be willing to change such policies and procedures according to current laws and compliance mandates.
  • Accurate Data: Ensure completeness and accuracy of information provided to carriers for contracting and credentialing. Accurate and complete data should be entered into all required fields. Updates the facility contracting sheets with updates as received. Uploads all documentation to OneDrive and ensures timely upkeep of expiring documents. Monitors and corresponds with providers regarding applicable expiration and renewals of licensures and certifications.
  • Credentials Files: Create and maintain credentials files on physicians and individual providers in company OneDrive. Files are maintained with accurate, up to date information easily available for retrieval.
  • Negative Issues/Actions Found: Identifies trends and any negative information found with immediate notification to the Contracting Supervisor. Requests follow up documentation as necessary.
  • Practitioner Profiles: Prepares practitioner profiles and obtains data from other departments as required and prepares files for review. Compiles data and organizes for department executive and owner reviews.


Responsibilities


  • Complete facility in network contracting applications and submit them to the payer with supporting documentation as assigned.
  • Enter Provider Enrollment Application information as required by each Insurance Carrier into OneDrive and other documentation tools.
  • Assist in any initial research for facility credentialing as requested and support the credentialing process for all accounts to ensure every account is appropriately credentialed with each insurance carrier.
  • Schedule follow-up phone calls on pending credentialing applications.
  • Sets daily, weekly, and monthly tasks to keep providers current in all aspects of credentialing.
  • Adheres to documentation protocol, notates accounts, and reports appropriately to the contracting team.
  • Maintains and updates account records including facility data information, documentation, application updates, and licenses.
  • Commits to providing excellent customer service while maintaining the highest degree of professionalism while working in a team environment to meet goals.
  • Understand facility licensing for all required states - Completes in-network requests and applications for all facilities.
  • Participates in companywide and departmental meetings.
  • Strategizes with key members of the collections team and cross-departments to increase accuracy, improve processes, and meet goals.
  • Promote a friendly work culture that encourages a fun, collaborative, and co-learning environment that benefits individuals’ well-being, self-improvement, and potential growth.
  • Perform other related roles and team function duties as assigned by the department supervisor and group leaders.
  • Attend and participate in Teams meets as required within the company as well as with facility accounts.


Qualifications

Required Education Level: High School Diploma or Equivalent

Additional Qualifications, Skills & Attributes


  • 2+ years of facility contracting experience
  • 1+ years of experience credentialing in Mental/Behavioral Health for the following credentials: LCSW, LMSW, MD, DO, NP/PMHNP, etc.
  • State Medicaid Experience Required
  • Medicare Experience Required
  • Experience working with online payer resources.
  • Familiar with credentialing for (but not limited to): Aetna, Ambetter, BCBS (All states), ComPsych, Evernorth, Humana, UHC/Optum, Tricare (East & West), VA, and CAQH.
  • Attentive to detail, goal-oriented, and able to follow instructions independently.
  • Commitment to excellent internal and external customer service
  • Ability to work efficiently with minimal oversight and within deadlines.
  • Excellent written and verbal communication abilities
  • Strong interpersonal skills and ability to work in a team environment.
  • Ability to set, prioritize, manage, and complete multiple tasks within deadlines.
  • Proficient with utilizing a diverse range of technology platforms and systems (Microsoft Office required, companywide platforms/software like Kanban and EHR/EMR platforms when applicable)
  • Intermediate computer skills and technical aptitude required.
  • Job Description Responsibilities and Qualifications are subject to change based on the needs of the Business


Benefits

We offer a comprehensive benefits package that includes:


  • Competitive Pay
  • Medical, Dental and Vision Insurance
  • Generous PTO
  • Short Term Disability
  • 401k with employer match


Compensation & Employment Details

Pay Range: $40k-$50k

Pay Type: Salary

Compensation Determination:

Our compensation salary ranges or pay rates are determined by various factors.


  • Job Qualifications, Job Responsibilities, Job Employment Level
  • When applicable, Location, Licensure & Certifications, Specialty Experience, etc.


Salary

$40,000 - $50,000 per year