Provider Contracting Manager jobs in Idaho

Job Title: Manager, Payer Contracting & Credentialing

Reports To: Revenue Cycle Management Leader

Location: Onsite - Meridian, Idaho

Northpoint Recovery Holdings, LLC, established in 2009, is a growing, behavioral healthcare treatment platform treating adults with substance use disorder and co-occurring conditions under the Northpoint Recovery brand and adolescents with mental healthcare conditions under the Imagine by Northpoint brand. The Company serves patients with commercial health insurance and is an in-network model. Northpoint has grown from two facilities to fifteen today entirely on a de novo basis with plans to expand rapidly in both existing and new markets. Organizational values include humility, heart, inspiration and conviction. Our commitment to excellence means doing good for others and engaging in innovative empirical based treatment. In short, our mission is to help people get their lives back and show them respect and empathy in the process.

POSITION SUMMARY: As a key member of the Northpoint team, the Manager of Payer Contracting & Credentialing is responsible for overseeing, improving, and ensuring a smooth payer contracting and credentialing process that is accurate and compliant with applicable payer and regulatory requirements. This position is responsible for managing the credentialing and re-credentialing process, managing payer contracts, and establishing and coordinating the negotiation of the terms and rates applicable to those contracts. This person manages and monitors processes and procedures that support licensing, credentialing, re-credentialing, expirable data management and delegated credentialing process to ensure compliance with CAQH standards, state and federal regulations and individual health plan requirements, and regulations pertaining to Medicare and Medicaid programs. This position manages new applications, and maintaining all organizational licenses, certifications, and registrations to ensure compliant business operations through the development of staff, maintenance of work integrity, and enhancement of team performance.

ESSENTIAL RESPONSIBILITIES AND DUTIES INCLUDE BUT ARE NOT LIMITED TO THE FOLLOWING:

• Responsible for technical and facility base payer contracting, credentialing, and pricing for Northpoint
• Responsible for the overall management of all in-network and out-of-network contracting and negotiations for the organization and employed provider
• Build an effective multi-state licensing and credentialing strategy and process that can scale nationally, coordinating between providers, medical boards, payers and government agencies
• Coordinate with clinical operations, licensing agencies, insurance carriers, and other appropriate organizations to complete credentialing and recredentialing applications
• Maintain a database for licensing, contracting and credentialing and continues to develop new processes and procedures; ensuring full utilization of systems and platforms
• Monitor entity-specific rules, policies, and procedures, ensuring compliance with accrediting organization and payer requirements; develops, recommends and/or implements changes, revisions and enhancements as appropriate to the current operating environment
• Effectively communicating on detailed and complex topics, such as healthcare industry specifics, market dynamics, trends, regulations and payer environment
• Perform full life-cycle contract management for a large portfolio of high value contracts
• Provide technical expertise in developing, organizing, and processing contracts and facilitate the approval process of all contract documents from pre-contract through post signature phase
• Facilitate operationalizing payer contract requirements with cross-functional teams. Works with the broader team to ensure steps or protocols are in place based on payer contract language
• Pursue regular rate increases with contracted payers
• Evaluate and monitor contract performance to determine necessity for amendments, updates, or extensions of contracts, and compliance to contractual obligations
• Audit charge master in billing software system and update to reflect annual COLAs and rate increases as needed
• Provide RCM team with applicable payer updates to policy manuals, medical necessity guidelines, as needed
• Ensure contracts have correct HCPCS/CPT codes for services offered
• Pursue professional services/specialty medication coverage contracts
• Adhere to all company policies and procedures
• Maintain confidentiality in accordance with established policies and procedures and standards of care
• Performs other related duties and special projects as assigned

QUALIFICATIONS/REQUIREMENTS FOR POSITION:

• Bachelor’s degree in business administration, health management, or commensurate experience required
• Minimum of five (5) years of experience in managed care contracting and provider credentialing
• Minimum of three (3) years of hospital and/or payer negotiation and payer analysis experience
• Knowledge of fee for service and/or fee for value reimbursement method, delegated credentialing workflows, and working knowledge of all major payers
• Strong at synthesizing information; easily distill easy-to-understand takeaways and next steps, diagnose problems, see patterns, and come up with targeted solutions
• Self-Starter; organize processes, improve workflows that already exist, and continuously strive for more efficiency
• Impeccable attention to detail; able to catch areas of opportunity in data or workflows quickly and document processes in a concise but thorough manner
• Must work well under pressure, able to focus on multiple priorities while maintaining focus, attention to detail and connecting all the dots
• Proficiency with Microsoft Office Suite

PREFERRED KNOWLEDGE AND SKILLS:

• Knowledge of behavioral health care HCPCS/CPT coding
• Business acumen and strong financial skills
• Able to maintain confidentiality of sensitive information
• Excellent communication skills: ability to communicate clearly and concisely, verbally and in writing
• Strong interpersonal skills to handle sensitive situations and confidential information
• Social ease and a demonstrated ability to build relationships with a variety of different people and personality types
• Ability to perform several tasks concurrently with ease and professionalism
• Ability to effectively prioritize workload in a fast-paced environment

REQUIRED CERTIFICATES/LICENSES/REGISTRATIONS:

• Must be at least twenty-one (21) years of age

SUPERVISORY RESPONSIBILITIES:

• Direct supervisor for contracting and credentialing staff

PHYSICAL DEMANDS AND WORK ENVIRONMENT:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Job performed at a desk in front of a computer.
• Requires heavy use of mouse and keyboard.
• Indoor office environment
• Though this position is not permanently located in a treatment facility setting, exposure to emotionally impaired patients is possible, and may be frequent. Stress ranges from low to high, depending on the situation.

CONDITIONS OF EMPLOYMENT:

• Completion of a tuberculin screening during first week of employment
• Completion of a pre-employment drug screening, post-accident and upon reasonable suspicion of use
• Completion of orientation and required paperwork prior to reporting to work
• Demonstrated computer literacy
• Attendance at all mandatory staff development and training
• Completion of background and professional reference checks

Job Type: Full-Time

Compensation:

• $69,000 - $85,000 annual salary

Full-Time Benefits Include:

• 85% Employer Paid Medical premium for employee level coverage – spouse and dependent premiums are subsidized at 50%
• 100% Employer Paid Basic Life Insurance equal to 1x annual salary
• 100% Employer Paid Employee Assistance Program
• Voluntary Dental, Vision, Short-Term Disability, and Supplemental Life & AD&D Insurance
• Pre-tax Savings Accounts for all IRS-allowable medical and dependent care expenses
• Generous Paid Time Off plan and 10 paid holidays annually
• Employee Referral Bonuses
• 401K Retirement Plan & Employer Match
• Free counseling services and resources for emotional, physical and financial wellbeing
• Consumer discounts through LifeMart
• Free parking!

Ability to Commute/Relocate:

• Meridian, Idaho; reliably commute or plan to relocate before starting work (Required)

This job description is not intended, and should not be construed, to be exhaustive lists of all responsibilities, skills, efforts or working conditions associated with this job. It is meant to be an accurate reflection of the principal job elements essential for making fair pay decisions about jobs.

Employees with potential access to protected health information must comply with all procedures and guidelines governed by HIPAA.

Northpoint is an Equal Opportunity Employer. Northpoint is an At-Will employer. Employment may be terminated at any time by the employee, or employer with or without notice.