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Payer Relations/Credentialing And Rate Variance Specialist

Company: Sunshine Behavioral Health
Location: Colorado Springs
Posted on: January 21, 2023

Job Description:

Payer Relations/Credentialing and Rate Variance SpecialistLocationDenver MetroHybrid 3 days office, 2 days homeCompensationsSalary - $55,000 $58,000DescriptionThe Payer Relations/Credentialing and Rate Variance Specialist will act as the Central Billing Operation (CBO) liaison to all contracted and non-contracted payers. Coordinates regularly scheduled meetings with contracted payers and CBO Leadership to resolve credentialing issues, customer service issues, global payer rejections, denial trends and other pertinent issues having a negative impact on revenue cycle. Maintains expanded knowledge base of contracted payer/product lines, credentialing requirements, claim requirements, electronic support tools (e.G. web link, ERA), payer policies, payer process/procedure to support CBO end user functions/tasks. Effects system and process/workflow updates with the timely review and distribution of contracted payer updates, bulletins, and newsletters. Ensures that updates have been completed accurately and timely to drive positive revenue cycle results. Provides direction, based on contracted payer communications, to the appropriate CBO departments. Ensures that the credentialing requirements for commercial managed care insurers/networks are met and managed appropriately and timely so that physicians are enrolled in and maintain active credentialing status with such entities.ResponsibilitiesFacilitates and tracks requests to Credentialing for credentialing paperwork submissions required to complete payer enrollment and contract executionTracks requests to RCM and monitors to confirm completion of contract term loading through billing set upTracks and mass appeals underpayments from contracted payersEnsures that the RCM team has correct rates loaded into CMD for all contracted payersManages database of payer agreements and reimbursement rates for various treatment lines of businessIdentify and resolve global payer issues that negatively impact the revenue cycle.Participates on the Denials Committee to identify denial trends that require payer follow up.Identifies opportunities for payer specific training and partners with the Revenue Cycle Specialists to deploy training in the MarketsCultivates positive and productive relationships with SBH contracted payer Provider RepresentativesAddresses all global payer issues and credentialing issues with Provider Representatives and works with payers achieve resolutionCredentials/enrolls new SBH facilities with in-network and out of network payers.Monitors timeframes to ensure that credentialing is completed timely thereby minimizing credentialing write offsMaintains broad knowledge of payer policies and billing guidelinesAwareness of product lines that may be excluded from current in-network contracts.Comprehensive understanding of payer portals available to streamline Front End processes.Stays abreast of payer communications and policy changes that impact credentialing and billing requirements.Enters and maintains information in credentialing databases.Runs database queries and reports as needed.Ensures that all data on shared drives is kept accurate and currentComplete enrollment/credentialing and re-credentialing applicationsRequired qualifications3-5 years of prior enrollment or credentialing experience.Demonstrates strong business acumen, data analytic skills, management/supervisory skills, and experience with project management and customer relationship management.Experience in the medical billing field and/or healthcare provider relationsCollege degree is preferred.Proven customer service, client relations, and claims resolutions experienceProfessional demeanor with a self-starter attitudeAbility to work independently as well as in a team environment.Proficiency in Microsoft Office SuiteStrong written and verbal communication skills with customer service focused aptitudeDetail-oriented individuals who are team players and highly self-motivated.Ability to multitask in fast paced environments.Strong reporting expertise with ability to provide status report and escalation where necessary.

Keywords: Sunshine Behavioral Health, Colorado Springs , Payer Relations/Credentialing And Rate Variance Specialist, Other , Colorado Springs, Colorado

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