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Credentialing Coordinator

New Season

Maitland, FL

Not provided

Not provided

1 month ago

Job Description

 

New Season:

 

For over 30 years, New Season Treatment Centers have been a leading national health care service provider of outpatient treatment centers that specialize in providing safe, quality and best in class care for individuals living with Opioid Use Disorder ("OUD").

 

Operating in over 70 treatment centers in multiple states, our team members are engaged in medication-assisted treatment, counseling, support, and care management of individuals living with OUD. We treat the whole person and, in so doing, address the underlying causes of OUD in an effort to provide a continuum of care that not only addresses treatment needs but supports the patient on their journey to recovery.

 

Job Summary:

 

Responsible for performing and maintaining the enrollment in health insurance plans, state Medicaid entities and Medicare for the company's multi-state clinics. Ensure that the terms of all contracting documents are accurate and in compliance with company policy. Establishes and maintains working relationships with all payors by staying in constant communication with provider representatives/contract managers. Ensuring contract language is followed and pertinent information is provided to company management.

 

 

Essential Functions:

  Monitor updates and requirements for contracting for each individual plan to effectively implement rollouts to the clinics. Following up and monitoring all stages of the contracting process and plan application deadlines in order to update the Director of Payer Relations and Vice President of Revenue Management. Understand the terms of the contract with various payers and review contracts for signature. Assist in developing good payer relations by assisting the health plans by returning all required information in a timely manner. Reads all available memos, letters, or bulletins regarding the disposition of Medicare, Medicaid, third party health plans, and other pertinent collection memos. Maintains knowledge of current health plans and governmental payor requirements for credentialing clinics. Be able to interpret and analyze the executed contracts in order to properly relay pertinent information to various departments. Effectively communicate and assist leadership in identifying and resolving issues with healthcare insurance plans. Communicate with third-party payers, field personnel, and other departments regarding authorizations, claims, payment plans, and appeals. Demonstrates effective oral and written communication skills; maintains the required level of confidentiality and be able to use discretion when necessary; interacts effectively with employees at all levels. Assist the Director of Payer Relations with managing the day to day operations of the department and all assigned projects. Identify and facilitate any reporting requirements that may be present in contracts. Maintain a high level of accuracy and attention to detail when completing all required documentation. Remains in constant daily communication with team members regarding all aspects of payer relations. Properly communicate any changes or amendments to contracts to all appropriate departments/teams. Encourages team members to expand their knowledge base by learning new areas of Revenue Management and also encourage the willingness to perform duties outside of their day-to-day responsibilities. Maintains confidentiality and safeguards the operations of the business. Keep lines of communication open with the Clinic Operation Team to ensure individualized goals are met.

 

 

Essential Qualifications: Education/Licensure/Certification:  Bachelor's degree in business or related field is preferred. Required Knowledge: The candidate has knowledge of the credentialing and contracting process with third party healthcare insurance plans. Knowledge of major U.S. health plans, NPI Registry, taxonomies, EIN/Tax ID, claim forms, and governmental payor entities. Must be familiar with computers, medical terminology, ICD-10 and CPT coding, and modifiers. Experience Required: This position requires a minimum of 3 years' experience in credentialing/privileging with third party healthcare insurance plans or within a credentialing organization. Experience with behavioral healthcare organizations is a plus.

 

New Season provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.  

 
Bachelor's degree in business or related field is preferred

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