Contract Credentialing Analyst - Ambulatory Infusion Clinics (AIC)

Option Care Home Health LLC; Bannockburn (IL); On-site; USD 65,000 - 90,000; Full time

Job summary

Option Care Health, Inc. is seeking an Analyst, Contract Credentialing to manage the payer credentialing lifecycle from initial receipt to submission for existing and new pharmacies. You will independently complete complex credentialing requests, forms, attestations, and audits.

The role involves initiating communication with third-party payers, maintaining tracking systems, and ensuring compliance with state/federal regulations. A bachelor’s degree with credentialing experience is preferred.

Qualifications

• Bachelor’s degree and at least 2 years of payer credentialing or provider enrollment experience, OR a high school diploma/GED with at least 5 years of credentialing experience.
• Experience with provider credentialing applications or provider enrollment in the medical field.
• Strong time management, prioritization, organization and meeting deadlines across multiple projects.

Responsibilities

• Complete initial credentialing and re-credentialing applications, provider information and enrollment forms for participation in commercial medical and pharmacy networks.
• Communicate with third-party payers and internal teams to resolve non-compliance.
• Maintain internal tracking for credentialing requests, submissions and renewals.
• Use internal databases and policies to complete applications; escalate questions as needed.
• Maintain knowledge of state/federal regulations and credentialing requirements.
• Generate monthly demographic reports in standardized formats for internal customers.
• Respond to credentialing inquiries promptly and escalate as needed.
• Facilitate signature process for third-party payer agreements and letters of agreement.
• Complete credentialing/demographic information in contractual documents.
• Maintain relationships with Operations, Legal, Sales and other departments involved with payer contracts.
• Assist with ad hoc projects and tasks as assigned.

Skills

Time management

Detail oriented

Relationship building

Microsoft Word

Microsoft Excel

Education

Bachelor’s degree

High school diploma or GED with 5+ years credentialing experience

Tools

Microsoft Word

Microsoft Excel

Job description

Extraordinary Careers. Endless Possibilities.

With the nation's largest home infusion provider, there is no limit to the growth of your career.

Option Care Health, Inc. is the largest independent home and alternate site infusion services provider in the United States. With over 8,000 team members including 5,000 clinicians, we work compassionately to elevate standards of care for patients with acute and chronic conditions in all 50 states. Through our clinical leadership, expertise and national scale, Option Care Health is re-imagining the infusion care experience for patients, customers and team members.

Join a company that is taking action to develop an inclusive, respectful, engaging and rewarding culture for all team members. At Option Care Health your voice is heard, your work is valued, and you’re empowered to grow. Cultivating a team with a variety of talents, backgrounds and perspectives makes us stronger, innovative, and more impactful. Our organization requires extraordinary people to provide extraordinary care, so we are investing in a culture that attracts, hires and retains the best and brightest talent in healthcare.

Job Description Summary:

The Analyst, Contract Credentialing is responsible for the payer credentialing lifecycle from initial receipt to submission for existing and new pharmacies. The individual will independently complete complex credentialing requests, forms, attestations, and credentialing audits.

Job Responsibilities (listed in order of importance and/or time spent)

• Complete initial credentialing and re-credentialing applications, provider information forms, enrollment forms, disclosures, and attestations of providers for participation in commercial medical and pharmacy networks. Ensure accurate provider information is submitted.
• Initiates and engages in communication with third-party payers and internal teams to resolve any potential non-compliance.
• Maintain internal tracking system for credentialing requests, submissions, renewals; proactively submit credentialing renewals.
• Utilize internal databases, licensing, accreditation, and internal policies to complete applications. Identify questions that need to be escalated for review by Legal, Litigation, Risk, Compliance, Clinical, Operations, and Contracting.
• Demonstrate knowledge of state, federal regulations concerning credentialing. Maintains current knowledge of contracted plans or networks and credentialing requirements.
• Generate monthly demographic reports for internal customers in a standardized spreadsheet format, identifying recent changes and identifying upcoming changes. Complete monthly demographic reports on third-party payer’s format providing all necessary information including, but, not limited to, out-of-state enrollments, different provider types, changes from previous month, and service areas. Review with third-party payer to ensure expected data elements are provided accurately.
• Co-manage department email box used by internal and external customers, assessing credentialing or payer need. Respond to credentialing inquiries in a timely manner. Resolve basic contract questions, and escalates to appropriate colleagues as needed. Review incoming patient-specific letters of agreement for completion, and submission for approval.
• Facilitate the signature process of all third-party payer agreements and select patient-specific letters of agreement through internal contract lifecycle process utilizing e‑signature platform or original signature process, or through client’s e‑signature platform. Review document and potential revenue impact to determine the appropriate internal signer to comply with OCH policy.
• Responsible for completing any credentialing and/or demographic information required in a contractual document.
• Maintain successful working relationships with internal departments such as Operations, Legal, Sales, and any other departments that are involved with or impacted by third-party payer contracts.
• Assists with ad hoc projects, requests, and initiatives as assigned by management.

Supervisory Responsibilities

Does this position have supervisory responsibilities?

(i.e. hiring, recommending/approving promotions and pay increases, scheduling, performance reviews, discipline, etc.)

No

Basic Education and/or Experience Requirements

Bachelor’s degree and at least 2 years of experience in payer credentialing or provider enrollment OR a high school diploma/GED at least 5 years of experience in payer credentialing.

Basic Qualifications

Experience with provider credentialing applications or provider enrollment completion in the medical field.

Experience using time management skills such as prioritizing/organizing and tracking details and meeting deadlines of multiple projects with varying completion dates.

Experience building and maintaining excellent internal and external working relationships.

Intermediate level skill in Microsoft Word (for example: creating and modifying text styles, numbering and sorting lists, working with sections and columns, formatting tables, and using templates and using diagrams and drawing tools)

Intermediate level skill in Microsoft Excel (for example: formatting text and borders of cells, working with workbooks and worksheets, using range names, referencing cells, sorting, and auto filtering)

Detail oriented and able to manage multiple priorities, meet deadlines and adjust to changing priorities.

Preferred Qualifications & Interests (PQIs)

Bachelor’s Degree and at least two (2) years Home Infusion and/or Specialty Pharmacy credentialing