Dir of Revenue Cycle - Credentialing & Payor Relations

The Director of Credentialing & Payor Relations is responsible for managing a team of credentialing staff and enrolling and credentialing clinicians with various health plan contracts across the Northeast. In addition, the Dir of Credentialing & Payor Relations will be assisting the RCM Team in negotiating, maintenance, problem resolution and internal coordination of assigned managed care contracts and proposals. Works with the VP of RCM and others to manage the contract process. Acts as a service representative for internal clients and payors, scheduling in-services as needed and works to provide information to the Company to enable them to operationalize their managed care agreements. Job Responsibilities: Responsible for maintaining contracting and enrollment files and systems Coordinating credentialing with health plans and following up with them and be effective at escalating issues through proper, well-maintained relationships at the plans Responsible to manage an internal team and external vendor, measure staff productivity through data and reporting and Provide supervision and mentoring of future support staff Collaborate with the IT/ Data Warehouse team for delivery of accurate and timely credentialing information across the organization which drives scheduling, enrollment and billing accuracy. Through reporting, measurement and excellent communication, provide weekly updates on status to all organizational constituencies and provide dashboards and other tools that are widely distributed. System owner of the Credentialing software systems. Understanding of vendor management including highest and best system use, upgrades, reporting, and the importance of system accuracy Assist in the development of an overall strategy for the managed care activities. Review contract language, rate and fee proposals, complete market analysis comparisons and evaluate proposal and present to senior leadership and membership Participate, develop, maintain and communicate alternative payment methodologies (risk sharing, shared savings, bundle & global payment arrangements, pay for performance programs, etc.) Act as a liaison to internal customers, (Ops, Exec Team), and external partners (payer contracting and provider relations management) Disseminate and understand healthcare market and industry changes including impacts due to Affordable Care Act, State Health Exchange and regulatory requirements and communicate the impact of these changes to the stakeholders Provide supervision and mentoring of future support staff Follow-up and address with payers global contracting issues encountered by practices/members. Ensure and interpret payer compliance to contract language and provisions and follow-up on any issues as appropriate Develop, review and communicate operational and clinical requirements. Assist with pay for performance and bonus program settlement and distribution process Required Work Experience: 8 to 10 years Healthcare credentialing (multi-state), Managed Cared, Payer experience, preferably in the Northeast Education: Bachelor of Science (Required) What We Offer 401(k) & 401(k) Matching Health Insurance (Medical, Dental, Vision) Life Insurance Paid Time Off Job Type: Full-time