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Director, Payer Contracting

72% Flex
UNLIMITED HOLIDAYS - EXTRA HOLIDAYS - EXTRA PARENTAL LEAVE - LONG REMOTE PERIOD ALLOWED
Remote: 
Full Remote
Work from: 

Offer summary

Qualifications:

Previous experience in home health insurance verification or medical billing, Proficiency in Microsoft Office suite.

Key responsabilities:

  • Secure new contracts and negotiate rates with payors
  • Maintain insurance provider agreements and credentialing
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Kaplan Education XLarge https://www.kaplan.com/
10001 Employees
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Job description

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Job Title 

Director, Payer Contracting

Location

Remote/Nationwide, USA

Additional Location(s)

Employee Type

Employee

Working Hours Per Week

40

Job Description

SUMMARY

Secure new Graham Healthcare Group contracts, negotiating rates, and credentialing with current payors. Work closely with the Insurance and Authorization departments, keeping them updated on changes in contracts or payor requirements.

ESSENTIAL DUTIES AND RESPONSIBILITIES

include the following. Other duties may be assigned as necessary.

  • Initiate and maintain insurance provider agreements with all major insurance plans and managed care payers as requested by Intake, Insurance, and Clinical Management
  • Provide all credentialing information to payer sources as requested
  • Negotiate with payer sources to ensure proper rate for services for the initial agreement and review existing agreements on a regular basis for the need for any rate increase
  • Maintain statistical reports or spreadsheets on the providers to assist billing and authorization
  • Develop and initiate contract amendments for additional locations and services
  • Update company information with each payer source when there is a change in address or a new addition. Send letter to all payer sources according to payer notification requirements (generally 30 days)
  • Facilitate timely contractual problem resolution to minimize impact on the business
  • Interact with Business Development, Billing, and Authorizations regarding new contracts and payer requirements
  • Provide timely updates to appropriate internal contacts on status of contract requests
  • Work with Revenue Cycle Management to ensure correct rates are in each payor source setup in HCHB
  • Attach copies of all contracts to the payor source within HCHB
  • Perform payer website access administration (not training)
  • Manage, assign job duties, review time cards and conduct performance reviews for members of the team
  • Comply with Graham Healthcare Group’s Core Values and Core Competencies
  • Perform other duties as assigned

QUALIFICATION REQUIREMENTS

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

  • Previous experience in either home health insurance verification or medical billing
  • Understanding of in-network and out-of-network benefits
  • Proficiency in Microsoft Office suite
  • Demonstrates patience, flexibility, and cooperative attitude
  • Effective verbal and written communication skills with other office staff
  • Conscientious and detail- oriented

CERTIFICATES, LICENSES, REGISTRATIONS

Must have and maintain in good standing professional license, certificate, or registration, as applicable.

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, climb stairs, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.

The employee frequently lifts and/or moves up to 20 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

This job generally operates in a clerical office setting. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets, and fax machines. While performing the duties of this position, the employee may travel by automobile and be exposed to changing weather conditions.

NOTICE:

  • Successful completion of a drug screen prior to employment is part of our background process, which includes medical and recreational marijuana.
  • By supplying your phone number, you agree to receive communication via phone or text.
  • By submitting your application, you are confirming that you are legally authorized to work in the United States.

Graham Healthcare Group is an Equal Opportunity Employer

Required profile

Experience

Industry :
Education
Spoken language(s):
English
Check out the description to know which languages are mandatory.

Soft Skills

  • Effective Communication
  • Patience
  • Flexibility
  • Cooperation
  • Detail-Oriented

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