Hybrid Credentialing & Contracting Resource en Pennant Services

JOB SUMMARY

The Credentialing & Contracting Resource will support our provider services in managed care contracting and revenue enhancement strategies for all healthcare payers as well as assist in the preparation for changes in the healthcare industry.The Credentialing & Contracting Resource will negotiate managed care payer contract rates and terms, guiding the development of managed care relationships to ensure the timeliness and appropriateness of negotiated rates.Additionally, the Resource will negotiate contracts for new locations, ensure that contracts are updated for new services, manage contract terminations, conduct managed care education sessions, and develop and implement a strategic vision to accelerate the results of the Operations they will support.

DUTIES & RESPONSIBILITIES

• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the job.
• Engage in complex levels of contract development and negotiation with managed care payors, including but not limited to managed care organizations, ACOs, health systems, hospitals, physician organizations, and third-party administrators, while working with the Legal and Finance teams in analyzing margins based on costs and rates for existing and newly acquired operations. 
• Establish, plan, direct, and evaluate the implementation of tactical plan(s) that will ensure expansion and support of business operations into managed care relationships and bring consistency of contract-related criteria and guidelines to optimize financial performance and minimize risk for operations.
• Assist in the analysis of contract terms and rates, and coordinate the submission of amendments, changes in reimbursement, language changes, and assist in advising each operation of the risks and advantages of signing contracts. Identify, develop, and maintain effective relationships with managed care payors and managed care/healthcare regulatory agencies. 
• Provide guidance and training as applicable to assist Field Operations partners in accelerating the results of the Field.
• Monitor industry changes, market trends, and events to identify opportunities to enhance and safeguard operations, proactively manage care revenue, and present as a subject matter expert regarding applicable changes in the healthcare industry.
• Coordinate and assist with any operations with any issues, such as contract cancellations and denials/appeals.
• Effectively communicate at all organizational levels and in situations requiring education, consultation, instruction, persuasion, negotiation, and advisement, as a consultant will serve as an internal managed care subject matter expert to Presidents, Executive Directors, and Service Center leadership personnel.
• Teach, train, and advise operational leadership on how to administer their managed care contracts by the creation and distribution of tools, training, and resources for leadership, AR team, Intake personnel, Case Management, and all other Operations or Service Center team members as needed.
• Assist the AR team with high-level managed care claims issues and projects to ensure the timely collection of monies due.
• Serve as primary liaison for all operations by distributing to the operations and service center all key contract terms and rates for all new and existing managed care payer contracts.

JOB REQUIREMENTS (Education, Experience, Knowledge, Skills & Abilities)

• Bachelor’s degree in business administration, management, or health care administration preferred.
• 5 + years’ experience in managed care contracting with a managed care payer or provider organization.
• Analytically oriented with the ability to communicate complex financial matters in a concise, professional manner.
• Must be knowledgeable about the managed care environment, including Medicare Advantage, Commercial, and Managed Medicaid products (HMO, PPO, EPO, POS, and Special Needs Plans) as well as knowledge of Accountable Care Organizations (ACOs) and value-based purchasing strategies.
• Work collaboratively as part of the Managed Care Team.
• Knowledge of managed care payer contract language and terms, standard requirements, and negotiated rate methodology to support contract compliance and analysis.
• Must be able to prioritize, plan, and handle multiple tasks/demands simultaneously and have strong analytical and problem-solving skills with keen attention to detail and an aptitude for accuracy.
• Excellent verbal and written communication skills, as well as excellent critical thinking skills.
• Maintain confidentiality and comply with the Health Insurance Portability and Accountability Act (HIPAA).
• Knowledge of Home Health, Hospice, Private Duty, and Assisted Living Facility operations is a plus.
• Ability to be flexible, adaptable, and work in a rapidly and constantly changing environment
• Knowledge of CPT-4, HCPCS, Revenue, and ICD coding.
• Strong computer skills (MS Word, MS Outlook & Excel) with Smartsheet knowledge a plus.
• Must be able to travel.

Please note that this job description has been designed to outline the general nature, working conditions, and level of work performed by employees in this role. It is not intended to be a comprehensive inventory of all duties, responsibilities, working conditions, and qualifications required of employees assigned to this job. Duties, obligations, and activities are subject to change at any time, with or without notice. Additionally, the incumbent may be required to perform job-related tasks beyond those stated in this description.