Part-time Payer Contracting & Credentialing Specialist

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🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $50 / hour

⏱ Part Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 0%

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Atlantic Health Strategies™

WebsiteLinkedInAll Job Openings

11 - 50 employees

Founded 2020

💼 Consulting

⚖️ Legal

📦 Logistics

Consulting • Legal • Logistics

Atlantic Health Strategies™ is a full-service operations and compliance partner for behavioral health, mental health, eating disorder, freestanding psychiatric, and addiction treatment providers. The company offers outsourced managed services and hands-on operational support — including compliance and accreditation, state licensure, HR outsourcing and payroll, EMR implementation and support, IT managed services and HIPAA/security, payer contracting, revenue integrity, and regulatory/M&A advisory — to help providers launch, scale, and remain payer- and regulator-ready while improving patient outcomes.

📋 Description

• Prepare and submit commercial and Medicaid organizational applications. • Coordinate managed care organization (MCO) enrollment and revalidation. • Track contracting milestones, renewals, and outstanding requirements. • Review payer contracts and fee schedules, identify reimbursement variances, and flag operational or financial risks. • Manage organizational Type 2 NPI enrollments and service location additions. • Verify taxonomy alignment with licensed levels of care. • Coordinate applicable CAQH profile updates. • Conduct focused reviews of behavioral health CPT and HCPCS billing practices against payer policies, covered services, and fee schedule requirements. • Evaluate authorization and documentation requirements. • Analyze denial patterns and recommend corrective actions to leadership. • Research state Medicaid fee schedules, managed care reimbursement structures, and provider manuals. • Prepare written findings supporting expansion into new states. • Summarize reimbursement findings and potential financial impacts for executive review. • Maintain accurate contracting and enrollment records. • Work primarily asynchronously and via email, with occasional Microsoft Teams meetings.

🎯 Requirements

• At least three years of behavioral health payer contracting experience, including Medicaid MCO enrollment and commercial payer contracting. • Working knowledge of behavioral health CPT and HCPCS codes, level-of-care billing requirements, and ASAM levels of care. • Demonstrated ability to interpret Medicaid fee schedules, payer policies, and contract provisions to identify reimbursement discrepancies and operational risks. • Strong written communication skills, with the ability to deliver clear findings and actionable recommendations within established timelines. • Ability to prioritize assignments, manage deadlines, and exercise sound judgment within a defined scope focused on contracting, credentialing, and analysis. • Multi-state Medicaid experience preferred. • Experience supporting a consulting organization, management services organization (MSO), or multiple facilities preferred.

🏖️ Benefits

• Meaningful Work: Support an organization committed to ethical, high-quality behavioral health and substance use disorder treatment. • Flexible Schedule: Work remotely approximately 10 hours per week, with primarily asynchronous responsibilities and occasional scheduled meetings. • Professional Impact: Apply your expertise to strengthen payer relationships, support reimbursement accuracy, and improve financial and operational performance. • Part-time W-2 employment.

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