Manager of Contracts and Credentialing

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Always Compassionate Home Care provides the highest quality of community home-based services, combined with exceptional compassion and innovation to enhance each patient’s quality of life. By bringing together several of the top home health agencies in the state, we have become one of New York’s leading providers with strategically placed offices that serve thousands of clients every day.

Title: Manager of Contracts and Credentialing

Location: Melville, NY (on site)

Salary: $80,000-$90,000, based on experience

Overview:

The Manager of Contracts and Credentialing will be primarily responsible for maintaining Always Compassionate Health contracts in all locations. He/she will also be responsible for securing new payor contracts, renegotiating reimbursement rates for current contracts. He/ she will complete initial and subsequent recredentialing packages for all new and current payor contracts. Keeps abreast and communicates to senior management all new and emerging regulatory mandates, trends directly impacting the organization’s ability to meet its contract deliverables on each payor.

***The position is based on site at our Melville, NY office (Mon-Fri). Candidates must reside in/near this location to be considered for this opportunity.

Responsibilities:

• Establish a Contractor/Payor Monitoring tool that specifically indicates the following: Contract, Contract validity dates, negotiation date, expiration date, reimbursement rates per contracted services.

• Monitor license and credential expiration dates and advise senior management of required “renew by” dates

• Consult w/senior management on contract negotiations, rate setting, amending/updating contract deliverables and other matters significantly affecting the organizations; ability to get fair reimbursement pricing.

• Create and maintain licensing, credentials and insurance records, facility audit reports and corrective measures, need for submission for credentialing and re-credentialing processes.

• Conduct research on updated state and federal regulations and policies impacting the organization’s contract negotiations. Provide research information to senior management.

• Release information to requesting contractors/payors, agencies and public inquiries when required by law, by the organization’s license mandates, contract negotiations, and other regulatory requirements.

• Conduct information training to members of the management team on contract stipulations related to service delivery requirements, i.e., client compliant resolution, securing service authorizations, submission of routine contract required reports, and billing disputes, creation of user ID and password for billing and authorization purposes.

• Ensure the facility and staff members are maintaining compliance with regulatory and accrediting institutions.

• Establish a tracking tool to monitor the following information that strengthens our ability to sustain our contracts and increase our leverage in renegotiating our contracted rates: intakes admitted to our care, cancelled service hours, client complaints – substantiated an unsubstantiated, payor and government regulatory audit findings.

• Provide quarterly QA reports to the Chief Regulatory Officer prior to presentation to QA Meetings

• Prepare compliance and contract performance reports as needed.

• Attend community meetings where he/she establishes contracting relationships with potential payors and gather information on how to reenforce our operations from industry competitors.

• Perform other duties assigned by the Chief Regulatory Officer

Qualifications:

• Bachelors degree; Master’s degree in business administration, Health Care Administration, Behavioral Science, preferred

• Management-level experience in public administration, government contracting, managed care provider relations, health care or community services

• Demonstrated proficiency in securing, negotiating, and maintaining healthcare contracts.

• Action-oriented, entrepreneurial stance, flexible, and adopts innovative approach to contract and operational management

• Ability to handle multiple tasks

• Excellent problem solving skills

Benefits:

• 401(k)

• Health Insurance

• Dental/Vision<