Credentialing and Payor Relations Specialist

Freddie Mac; United States; Remote; USD 60,000 - 80,000; Full time

Job summary

A leading home infusion provider is looking for a Credentialing and Payor Relations Specialist to oversee Payor management and credentialing processes. This role collaborates with multiple departments to ensure compliance and effective operational strategies, requiring strong experience and communication skills within the realm of managed care and payor relations.

Qualifications

• Minimum 5 years' experience in payor relations or related fields.
• Experience working for a national or regional payor or managed care organization.
• Knowledge of managed care contracting and contract negotiations.

Responsibilities

• Manage CPR+ Payor Files and assist with payor management.
• Oversee the provider credentialing process for compliance.
• Develop resources for managed care and revenue cycle management.

Skills

Communication

Problem Solving

Financial Analysis

Education

Bachelor's degree

Tools

Microsoft Office Suite

CPR+ Pharmacy Management System

Job description

InfuCare Rx is a leading home infusion provider accredited by URAC and ACHC, offering specialized care for patients requiring IV therapy and specialty pharmacy services in the homecare setting. We foster an ethical, team-oriented, and quality work environment that promotes achievement and success.

Job Summary: The Credentialing and Payor Relations Specialist will support all functions related to the development and management of CPR+ Payors. This role collaborates cross-functionally with Intake, Operations, and Revenue Cycle Management to optimize CPR+ usage. Responsibilities include payor management, contract facilitation, documentation maintenance, and tracking. The position reports to the National Director of Contracting and aids in developing strategies and resources for Managed Care, Revenue Cycle Management, and Intake departments.

Primary Responsibilities:

• Manage CPR+ Payor Files by creating and maintaining payor records.
• Assist Payor Management with CPR+ Payor requests and setup.
• Update Payor Specific Fee Schedules within CPR+.
• Develop Payor-related resources for RCM and Intake teams.
• Collaborate with the National Director of Contracting to develop contract implementation resources and policies for CPR+ Payor Management.
• Oversee the provider credentialing process to ensure compliance with federal, state, payer, and facility requirements.
• Coordinate, submit, track, and maintain credentialing documents for initial, re-enrollment, and re-credentialing processes.
• Stay informed of credentialing, payer enrollment, and regulatory updates, implementing necessary adjustments.
• Assist with payor portal updates and support EDI/EFT/ERA enrollment efforts.
• Communicate with internal departments to gather information required by payors.
• Resolve issues or discrepancies related to credentialing.
• Support Medicaid enrollments in collaboration with the National Director of Contracts.
• Perform other duties as assigned.

Education/Experience:

• Bachelor's degree required; equivalent education/experience may be considered.
• Minimum 5 years' experience in payor relations or related fields.
• Experience with managed care contracting, financial analysis, and contract negotiations.
• At least 5 years' experience with CPR+ Pharmacy Management System.
• Proficiency with Microsoft Office Suite.
• Experience in the acute or specialty infusion pharmacy industry.
• Experience working for a national or regional payor or managed care organization.

Preferred Qualifications:

• Effective communication skills, both written and verbal.
• Ability to analyze and interpret business and regulatory information.
• Strong problem-solving skills and financial data interpretation.

Physical Demands:

Must be able to stand, walk, sit, talk, hear, operate office equipment, and occasionally lift up to 25 lbs. Vision requirements include close, distance, peripheral vision, and focus adjustment. Reasonable accommodations may be provided to enable individuals with disabilities to perform essential functions.

InfuCare Rx is an equal opportunity employer. We do not discriminate based on race, color, religion, national origin, military status, marital status, citizenship/immigration status, sex, age, disability, genetic information, retaliation, or participation in discrimination proceedings. Background checks and drug screens are part of our hiring process. We are committed to affirmative action and equal employment opportunity for minorities, females, disabled persons, and veterans.