Contracting & Credentialing Manager Addison TX Full Time
From our Dallas corporate headquarters to our clinics and worksite locations, Concentra colleagues remain focused on our driving purpose: to provide superb patient and employer experience by delivering the highest quality healthcare in an efficient, affordable, caring manner. We do this by putting all customers (internal and external) first and by displaying:
- A healing focus
- A selfless heart
- A tireless resolve
Negotiates, obtains, implements and administers Group Health payer contracts in accordance with company and department policies and procedures, applicable laws and customer requirements, ensuring support of the growth of revenue of CHS’ Group Health strategic initiative. Assists with acquisition transition to insure uninterrupted revenue flow. Supervises payer credentialing process and specialists.
- Contacts payers to negotiate and obtain group health payer contracts, and finalize rates and contract language with payer representative. Implements and maintains group health contracts including physical therapy, urgent care and other services as requested. Assists with all other contract requests as needed.
- Monitors current agreements for recommendation on timely negotiations and modifications and additions.
- Evaluates new contract proposals from payers.
- Assists in acquisition transition to insure uninterrupted revenue flow.
- Supports written and verbal communications to payers.
- Supervises payer credentialing process and specialists.
- Works collaboratively Customer Support Services, Credentialing and payer related department personnel to provide or obtain information and resolve conflicts. Coordinates with Central Billing Office and other field staff on activities related to payer contracting, collections and operational issues. Assists other departments in understanding payer contracts and educates internal personnel on managed care and group health principals.
- Bachelors degree in business administration or equivalent experience to attain the skills normally acquired with the completion of a four year degree.
- Minimum of 8 - 10 years of senior healthcare experience in contract management, provider network, credentialing and claims management.
- Comprehensive work with contractual relationships and health delivery goals with group health and managed care payers
- Comprehensive knowledge of healthcare coding, billing and ability to resolve contract related claim issues.
- Comprehensive knowledge of contract administration, practices and accounting and finance principles.
- Comprehensive knowledge of payer credentialing.
- Comprehensive knowledge of processes and procedures involved in the transition of acquisition contracts to insure continued revenue flow.
- Proven ability to resolve contract and pricing issues
- Demonstrated successful negotiation skills
- Demonstrated ability to advise and interact with all levels of management
- Demonstrated excellent oral and written communication skills
- Demonstrated intermediate to advanced proficiency in using spreadsheet and database applications such as Excel and contract administration databases
- 401(k) with Employer Match
- Medical/Vision/Prescription/Dental Plans
- Life Insurance/Disability
- Paid Time Off/Holidays
- Colleague Referral Bonus Program
This job requires access to confidential and sensitive information, requiring ongoing discretion and secure information management.
Concentra is an Equal Opportunity Employer, M/F/Disability/Veteran.