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Manager of Payor Contracting and Provider Enrollment

Company: hireneXus
Location: Tempe
Posted on: November 22, 2021

Job Description:

Manager of Payor Contracting and Provider Enrollment This position is with a national specialty physician group based in the Phoenix area. The Manager of Payor Contracting and Provider Enrollment will lead a team of people who support the intake and enrollment of new providers in health plans. This position will also provide a knowledgebase to the entire team with regard to networks, health plan products, and health plan coverage details. This role will report to an RCM Director with 6 direct reports current. This number is expecting to double over the next year. Responsibilities

  • Manages department---s work queues and productivity reports to ensure timely submission of charges.
  • Serves as the initial point of contact to establish health plan contracts in various markets.
  • Negotiates contract terms with health plans and brings proposal to executive level for final approval and signature.
  • Facilitates dispute resolution involving claims and reimbursement issues between Revenue Cycle Management and health plan.
  • Maintains an accurate inventory of healthcare individual providers, groups, and locations in the database that feeds the credentialing and provider enrollment process.
  • Identifies providers who are contracted with various health plan products in a manner that is easy for users to understand.
  • Oversees the necessary steps to credential providers, as well as, performs routine periodic checks of various databases to assure integrity of the provider inventory.
  • Oversees the necessary steps to enroll providers in health plan products as needed.
  • Serves as project coordinator and information exchange for data requests that come into the Revenue Cycle Management service area, assuring that data requests are being completed.
  • Performs other related duties as assigned or needed for business continuity.
  • Serves as subject matter expert on:
    • Health plan architecture, product offerings, network restrictions, authorization, referral, and other components of the health plan marketplace.
    • Medicare Choice and Medicaid managed care plans in national markets.
    • Health plan verification of benefits and coverage. Job Requirements:
      Qualifications/Education/Credentials
      • Bachelor---s Degree preferred.
      • Knowledge and experience with provider enrollment, credentialing and contracting.
      • Knowledge and experience with health plan markets.
      • Knowledge and experience with health plan products.
      • Knowledge and experience with health plan benefits.
      • Detail oriented, professional attitude, and reliable.
      • Proficiency with Microsoft Office Suite.
      • Possess strong organizational and time management skills.
      • Ability to interact with all internal and external customers in a professional manner.
      • Ability to communicate effectively both verbally and in writing.
      • Ability to manage multiple priorities successfully and drive results.
      • Ability to define, analyze and resolve issues quickly and accurately.
      • Demonstrated leadership ability. --

Keywords: hireneXus, Tempe , Manager of Payor Contracting and Provider Enrollment, Executive , Tempe, Arizona

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