Provider Contracting Director jobs in Tennessee

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Position Summary:

The Provider Contracting and Licensing Specialist is responsible for requesting group contracts and participation for providers in and with health plans to minimize the possibility of delay or non-payment of claims for services rendered by practitioners. Responsibilities may include obtaining licensure  for providers in multiple states and following up to ensure timely completion.

ESSENTIAL FUNCTIONS:

To perform this job, an individual must perform each essential function satisfactorily with or without a reasonable accommodation:

Candidate must be able to request a payor contract on behalf of a client and pursue the contract until completion. Detailed notes of all communications must be maintained.

Research payers for information on processes to enroll providers, obtain contact representative information, and verify the status of provider/group to determine if they are in the system or not.

Research requirements for licensure in multiple states and accurately complete all applications.

Complete CAQH credentialing process for new providers or groups accurately.

Monitor and maintain provider files to determine reason for pending enrollment and/or confirm all documents are received; request any additional documents and usernames/passwords needed for enrollments; and routinely update status changes.

Follow-up with payers for effective dates and status updates on a regular basis. Must keep detailed notes on all communication with the payers.

Responsible for completing enrollment applications, re-credentialing applications, demographic updates, and documents requested by each payer for processing.

Update and maintain CAQH database with all current provider information that is received from the client as well as updated licenses, DEA and add locations to the provider as needed.

Monitor CAQH for expiring documents (i.e., license, DEA) and proactively contact client for updated information when required.

Perform routine administrative tasks to include but not limited to, processing applications, uploading and updated documents, notification forms, enroll provider(s) with all designated payers, and research process with payer in a timely manner.

Research payer enrollment questions and issues raised by clients and respond with resolution.

Complete and follow-up on Hospital re-appointment applications as requested by practice.

Candidate must be able to negotiate and review contracts for practices.

REQUIREMENTS:

Candidate must have 3 years of payor contracting/ payor enrollment experience.

Candidate must be proficient in Microsoft Office products

Candidate must be able to work independently on projects and communicate project status to supervisor and client in a professional manner.

Candidate must be detailed oriented and able to multi-task effectively.

Supervisory experience a plus.