Managed Care Contract Specialist

About Us: Relief Mental Health provides Transcranial Magnetic stimulation, esketamine, therapy and psychiatric medication management to patients with depression, OCD, and other mental health diagnosis. We aim to create a new standard for mental health care, offering a continuum of innovative therapeutic interventions and responding to evolving patient needs. Relief Mental Health has 12 clinics in 4 states and is continuing to grow. Summary: The Managed Care Contract Specialist is responsible for maintaining active status for all providers by successfully completing initial and subsequent credentialing for all payors commercial and government related. Essential Duties and Responsibilities:

• Initiate credentialing and re-credentialing applications for both individual providers and provider groups.
• Sets up/ maintains provider information in online enrollment databases, health plan and internal systems
• End-to-end credentialing process of all new and current providers, and with all contracted Insurance companies in multiple states.
• Oversee the screening of practitioners' applications and supporting documentation to ascertain their eligibility.
• Maintains confidentiality of provider and payer information
• Manage, negotiate, and renegotiate fee schedules to obtain the most optimal rates.
• Maintain individual provider files to include up-to-date information needed to complete the required governmental and commercial payer and credentialing applications.
• Maintain internal provider tracking database to ensure all information is accurate and logins are available.
• Update each provider's CAQH database file timely according to the schedule published by CMS
• Apply for and renew prior to expiration all provider licenses: professional state, DEA, and controlled substance registration.
• Complete revalidation requests issued by government payers.
• Complete credentialing applications to add providers to commercial payers Medicare, and Tricare.
• Review weekly new hires and termination report to update in credentialing database.
• Respond to health plan provider inquiries.
• Oversee and maintain the licensing/credential database.
• Perform and collect documentation for licensing, board certifications, proof of professional liability insurance.
• Ensure credentialing database contains up-to-date information at all times.
• Responsible for monitoring credentialing/re-credentialing requirements, as well as required certifications, and to ensure the collection of all required renewal certifications are on file within the required time frame.
• Provide consistent and timely follow-up on all outstanding credentialing/re-credentialing files.
• Work closely with leadership to track and oversee Collaborative Agreements between Nurse Practitioners and Physicians.
• Ensure compliance with applicable laws, regulations, procedures, and policies.
• Maintain working knowledge of the National Committee on Quality Assurance (NCQA) standards and State and Federal regulations related to credentialing

Required Education and Experience:

• Bachelor's degree+ in Healthcare or Business Administration/related field or 5 years of relevant experience.
• 3+ years of credentialing experience with hospital or physician practice medical staff.
• Experience with submitting applications for State, Federal, and Health Plan credentials.
• Experience with submitting applications for State, Federal, and Health Plan contracts.
• Experience with CAQH (Council for Affordable Quality Healthcare) database and application process.
• Knowledge of credentialing and procedures and standards.
• Excellent verbal and written communication skills.
• Proficient touch-typing skills.
• Ability to focus for extended periods.Preferred Education and Experience:
• NAMSS Certification as a Certified Professional Medical Services Management (CPMSM) or Certified Provider Credentialing Specialist (CPCS) is preferred.
• Working knowledge of credentialing accreditation regulations, policies, and procedures, and NCQA standards essential.
• Experience with submitting and maintaining Collaborative Agreements between Nurse Practitioners and Physicians.

Knowledge, Skills, and Abilities:

• Ensures work product demonstrates attention to detail, accuracy and completeness.
• The ability to multitask is essential.
• Incredibly organized and meticulous attention to detail is a must.
• Critical thinking skills to identify opportunities and make informed decisions.
• The ability to track details, deadlines, and priorities to ensure no details or deadlines are missed.
• Self-starter who will take initiative and be proactive when there are multiple priorities.
• Ensures Ethical Conduct in all areas of work performance.
• Communicates with co-workers, management, vendors and others in a courteous and professional manner.
• Team player with excellent interpersonal skills.
• Strong written and verbal communication skills.
• Conform with and abide by all regulations, policies, work procedures and instructions.

What we Offer:

• Competitive 401K plan
• Partnership with Lifetime Fitness
• Health Insurance (Medical, Dental and Vision)
• FSA and Dependent Care FSA
• Short Term Disability
• Tuition Reimbursement
• PTO

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