Manager, Payer Relations, Contracting, Credentialing

🕒 Outubro 31

🥔 Idaho – Remoto

🥔 Idaho – Remote

💵 $70.000 - $90.000 / ano

⏰ Tempo Integral

🟡 Pleno

🟠 Sênior

👔 Gerente

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• Aberta há 11 dias.

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Northpoint Recovery

SiteLinkedInTodas as Vagas

201 - 500 funcionários

Fundada em 2014

🏥 Saúde

Healthcare • Mental Health • Addiction Treatment

A Northpoint Recovery é um centro abrangente de tratamento para dependência localizado em Boise, Idaho, oferecendo uma gama de serviços para adultos e adolescentes que enfrentam transtornos de uso de substâncias e problemas de saúde mental coexistentes. Eles oferecem programas personalizados de internação e ambulatoriais que incluem desintoxicação, terapia individual e tratamentos baseados em evidências como terapia cognitivo-comportamental, todos projetados para apoiar a recuperação duradoura e a prevenção de recaídas. Com foco em cuidado compassivo e em um ambiente terapêutico, a Northpoint Recovery visa ajudar os clientes a construírem futuros mais saudáveis e alcançarem a sobriedade.

Descrição

• Serve as the primary operational relationship owner for assigned health plans and payer partners • Develop and maintain strategic relationships with payer representatives, network leaders, contracting teams, and other stakeholders • Establish a structured payer engagement cadence for high-impact payer relationships • Identify and escalate payer issues affecting patient access, reimbursement, authorization, claims payment, or operational performance • Partner with Revenue Cycle Management and Utilization Review leadership on payer issue resolution • Monitor payer and market developments for financial, operational, and access opportunities or risks • Support payer strategy for new markets, de novo facilities, acquisitions, new service lines, and geographic expansion • Maintain a payer opportunity and escalation pipeline • Provide executive-level reporting on payer relationships, negotiations, network development, reimbursement opportunities, and material risks • Develop payer negotiation strategies with the EVP of Revenue Cycle Management and Finance • Build scalable multi-state licensing and credentialing processes • Evaluate reimbursement performance and identify contracts or rates requiring renegotiation • Maintain payer contract summaries covering reimbursement terms, authorization requirements, timely filing provisions, appeals, exclusions, and termination provisions • Quantify the financial impact of proposed rate changes and contract amendments with RCM analytics • Identify opportunities to expand network participation and improve patient access • Ensure negotiated contract terms are operationalized across Admissions, Utilization Review, Clinical Operations, Billing, and other functions • Manage the full lifecycle of contract management, negotiations, rate increases, HCPCS/CPT requirements, and professional services • Manage in-network and out-of-network contracting and negotiations for the organization and employed providers • Coordinate credentialing and recredentialing applications with clinical operations, licensing agencies, insurance carriers, and other organizations • Maintain licensing, contracting, and credentialing databases and develop related processes and procedures • Monitor entity-specific, accrediting organization, payer, state, and federal requirements and implement necessary changes • Analyze reimbursement by payer, authorization barriers, contractual adjustments, overpayments, underpayments, out-of-network exposure, network adequacy, rate performance, contract compliance, and patient access barriers • Perform other duties as assigned

🎯 Requisitos

• 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 methods, delegated credentialing workflows, and working knowledge of all major payers • Strong ability to synthesize information, distill takeaways and next steps, diagnose problems, identify patterns, and develop targeted solutions • Self-starter able to organize processes, improve existing workflows, and pursue efficiency • Impeccable attention to detail and ability to identify opportunities in data or workflows and document processes thoroughly • Ability to work under pressure and manage multiple priorities while maintaining attention to detail • Proficiency with Microsoft Office Suite • Knowledge of behavioral health care HCPCS/CPT coding preferred • Business acumen and strong financial skills preferred • Ability to maintain confidentiality of sensitive information preferred • Excellent verbal and written communication skills preferred • Strong interpersonal and relationship-building skills preferred • Ability to perform several tasks concurrently preferred • Ability to prioritize workload in a fast-paced environment preferred • Employees with potential access to protected health information must comply with HIPAA procedures and guidelines

🏖️ Benefícios

• Subsidized Health Insurance Coverage for Employee, Spouse, & Dependent(s) • 100% Employer Paid Basic Life Insurance equal to 1x annual salary, up to $100,000 • 100% Employer Paid Employee Assistance Program • Voluntary Dental, Vision, Short-Term Disability, Supplemental Life & AD&D, Critical Illness, Accident, and Hospital Indemnity Insurance • Pre-tax Savings Accounts for all IRS-allowable medical and dependent care expenses • Generous Paid Time Off plan • Employee Referral Bonuses • 401K Retirement Plan & Employer Match

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