Contract and Payor Credentialing Specialist

SUMMARY

The Specialist is responsible for identifying and securing public and private insurance contracts; reviews and organizes existing contracts. Assists with the development of potential relationships with strategic partners and creates measurable business results for various markets.

ESSENTIAL JOB FUNCTIONS

To perform this job successfully, an individual must be able to satisfactorily perform each essential function listed below:

Contracting and Credentialing

Works in partnership with Operations Leaders and Director of Contracts and Payor Engagement to ensure consistency and secure public and private insurance contracts

Analyzes and monitors financial aspects of existing contracts and maintains original documentation of all contracts

Identifies, contacts, and creates relationships with potential payors that result in new contracts and increased funding possibilities for program participants

Conducts rate and contract negotiations

Describes services provided to potential contract sources

Communicates with state directors, and state operating/marketing staff regarding contract specifics. Ensures commitments to participants, family, referral sources and payors are met

Communicates contract executions and requirements to all internal departments

Completes contract related credentialing and enrollment application requirements

Maintains database of licenses, accreditation forms, financial and organizational information for the purpose of efficient and timely enrollment application

Oversees Single Case Agreement process within the Admissions Teams. May take lead in difficult single case negotiation

Facilitates resolution of contract related issues with billing and collections team

Performs other related duties and activities as required

SUPERVISORY RESPONSIBILITIES

None

Minimum Knowledge and Skills required by the Job

The requirements listed below are representative of the knowledge, skill, and/or abilities required to perform the job:

Education and Experience:

Bachelor’s degree in Rehabilitation Administration, Business Administration or related field preferred, and/or

Three to five years’ experience with contracts, managed care, and health insurance related industry preferred

Certificates, Licenses, and Registrations:

None required

Other Skills and Abilities:

None noted

Other Requirements:

Occasional travel if needed

Physical Requirements

• Sedentary work. Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

AMERICANS WITH DISABILITIES ACT STATEMENT

External and internal applicants, as well as position incumbents who become disabled, must be able to perform the essential job functions either unaided or with assistance of a reasonable accommodation to be determined on a case by case basis via the interactive process.

Where you can work from

This job is 100% remote, for applicants who live in the United States.