Payer Relations/Credentialing And Rate Variance Specialist
Company: Sunshine Behavioral Health
Location: Colorado Springs
Posted on: January 21, 2023
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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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