Job description

Job Description

• Responsible for maintenance of the contracts of the assigned state.
• Works in collaboration with a billing team member and a credentialing team member to adequately maintain the post contractual obligations.
• Maintains the proper documents for all aspects of the maintenance of the FFS contracts.
• Maintaining all providers and contracts are credentialed with all product lines within a plan when working Out of Network Accounts Receivable.
• Maintains documents and emails in order to help resolves issues that affect contract performance and when necessary, escalate to Supervisor for resolution.
• Serving as an integral member of the FFS contracting team responsible for developing and maintain relationships with payers and MyCare departments to proactively and timely address and contracting/operational issues.
• Maintains excellent working relationship with payors.
• Participate in required One on One meetings with Supervisor and all requested/required meetings with internal MyCare Team on site or via Teams.
• Identifies appropriate contracting needs, interprets payer-specific requirements, and interacts with health plan counterparts, FFS Supervisor and other company team members to promote alignment.
• Coordinates with internal team members to ensure internal service line and operational needs are reflective in contractual language and operational or other contractual requirements are being adhered to and understood.
• Review and maintain up to date fee schedules and other items in the contracts timely and in accordance with specific contractual and internal timeframes.
• Maintaining updated fee schedules from payors. Evaluate current FS to what is in EHR system. *Reviews health plan policies and provider bulletins in order to identify relevant impacts to the FFS contracts.
• Communicate appropriate information to internal groups timely and efficiently.
• Maintains appropriate documentation and reviews contract performance and supports in the development of appropriate development of appropriate recommendations to leadership.
• Assist in providing support to Billing, Credentialing, EHR, and other MyCare team members, as applicable in relation to post contract maintenance.
• Researches issues that may impact future negotiations or jeopardize network retention.
• Ability to plan time effectively, balance multiple tasks, work within stringent time frames, and execute projects to completion.

Other Requirements/Responsibilities

• May require minimal travel within the associated state or to the CBO.
• Effectively manages emotions, listens, and communicates with respect, and builds trusting relationships.
• Effectively leverages resources to create exceptional outcomes, embraces change, and constructively resolves barriers and constraints.
• Meets established expectations and takes responsibility for achieving results, encourages others to do the same.
• Consistently models and inspires high levels of integrity, lives up to commitments, and takes responsibility of one’s actions.
• Detail oriented, critical thinking skills, organizational skills, interpersonal skills.

Qualifications

• Must have 3-5 years extensive knowledge and working aspects of Billing, Specifically Payor AR, a general understanding of Payors Portals, credentialing, financial analysis, for the purpose of working a denial or AR report.
• Experience with Verity Stream or similar contract databases preferred.
• eCW experience preferred.
• Knowledge of Medicare/commercial/other payer terminology and reimbursement Regulations.
• Excellent verbal and written skills.
• Problem solving skills.
• Proficient in Microsoft Excel, Word, PowerPoint.
• Skilled in analytics and decision support.
• Strong analytical ability.

This position is remote but will occasionally require the candidate to attend meetings and trainings in the office.

Req #: 44210

Career Site Link: https://www.paycomonline.net/v4/ats/web.php/jobs/ViewJobDetails?job=74923&clientkey=3299EE59415D0BACDAEAB325DD58603C

Job Type: Contract

Pay: $19.00 - $23.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Employee discount
• Flexible schedule
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Parental leave
• Referral program
• Vision insurance

Schedule:

• Day shift
• Monday to Friday

Experience:

• payor portal: 1 year (Required)
• credentialing: 1 year (Required)
• VLOOOKUP in Microsoft Excel: 2 years (Required)

Work Location: Remote

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