Manager of Contracting and Credentialing

Description

Summary

Responsible for the administration, data management and general oversight of all payor contracts along with the development of contractual relationships, including the negotiation of terms and maintenance of existing agreements. The Manager of Contracting and Credentialing manages the negotiation or renegotiation of contracts as appropriate and ensures that the terms our favorable to our Urgent Care Centers. This role is responsible for tracking the overall performance of our contracts, collaborating with the Accounts Receivable team and facilitating the resolution of any payment or contract compliance issues. The incumbent identifies new opportunities, develops strategies and responds to requests for proposals or contracts. The incumbent is responsible for ensuring that the contracts are complete, accurate and timely.  

Essential Duties and Responsibilities

• Leads contract strategy and execution and proactively manages overall contract performance (including any required due diligence, modeling, pay for performance programs).
• Leads and coordinates effective execution of new contracting, such as new joint ventures and acquisitions, mass re-contracting or contract integration efforts and direct employer contracting. 
• Identifies strategic opportunities to collaborate with payors or employers to favorably impact cost of care and reimbursement opportunities 
• Designs, updates, manages overall payor contracting data, including accountability for defining business processes around contract data, monitoring and maintaining data integrity, and standard reporting as requested
• Responsible for assisting with integrity of monthly reports and collaborating with the billing and finance team to define requirements and establish updated templates for contract performance management (underperformance/collection as well as pay for performance).
• Manages all contract tables that are placed into the billing systems to effectively report net revenue.  
• Maintains relationships with payors, internal key departments, and other third parties in order to enhance strategic relationships. This includes setting up quarterly meetings with payers to discuss issues.
• Educates revenue team and clinics about contractual obligations or any changes that occur that are contractually, or policy related.   
• Creates and monitors templates for timely filing risk by payer to be used by the AR managers.
• Works with the payers to understand their credentialing requirements. Monitors compliance and timeliness of these submissions by working with the billing managers.
• Oversees the credentialing team. Monitors and evaluates employee performance. Holds employees accountable for the attainment of defined goals and objectives. Executes effective performance redirection when needed. Develops employees through coaching, mentoring, and formal/on the job training and development opportunities
• Other task as needed

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Requirements

Competencies                      

To perform the job successfully, an individual should demonstrate the following competencies:

• Technical Skills - Strives to continuously build knowledge and skills; shares expertise with others.
• Customer Service - Responds promptly to customer needs.
• Interpersonal Skills - Maintains confidentiality.
• Oral Communication - Responds well to questions; participates in meetings.
• Written Communication - Presents numerical data effectively.
• Teamwork - Balances team and individual responsibilities; contributes to building a positive team spirit.
• Quality Management - Demonstrates accuracy and thoroughness.
• Business Acumen - Understands business implications of decisions; displays orientation to profitability.
• Cost Consciousness - Works within approved budget; develops and implements cost saving measures; contributes to profits and revenue; conserves organizational resources.
• Diversity - Promotes a harassment-free environment.
• Ethics - Keeps commitments; works with integrity and ethically; upholds organizational values.
• Organizational Support - Follows policies and procedures.
• Judgment - Exhibits sound and accurate judgment; supports and explains reasoning for decisions; includes appropriate people in decision-making process; makes timely decisions.
• Motivation - Sets and achieves challenging goals; demonstrates persistence and over