Director of Credentialing and Payor Contracting

Gilder Search Group; Henderson (NV); On-site; USD 95,000 - 105,000; Full time

Job summary

Une entreprise de soins de santé mentale bien établie recherche un Directeur de Credentialing et de Contractualisation des Assureurs pour superviser l'ensemble du processus d'accréditation. Ce rôle crucial est responsable de la gestion des négociations de contrats d'assurance et de l'intégrité des données des fournisseurs, tout en garantissant le respect des normes de conformité. Le candidat idéal aura un baccalauréat dans un domaine connexe et une expérience solide dans la gestion de l'accréditation, avec des compétences en leadership et en communication.

Benefits

Congés payés et jours fériés

Forfait de bénéfices complet (médical, dentaire, vision, vie, etc.)

Qualifications

• 2-4 ans d'expérience en accréditation médicale ou certification de spécialiste en accréditation.
• 3-6 ans d'expérience en tant que responsable de l'accréditation.
• Expérience dans des opérations de santé multistates est élevée souhaitée.

Responsibilities

• Gérer l'équipe d'accréditation pour assurer la conformité et l'exactitude.
• Diriger les négociations de contrats avec des assureurs.
• Développer des politiques d'accréditation conformes.

Skills

Communication

Leadership

Gestion de l'équipe

Analyse des contrats

Conformité réglementaire

Education

Baccalauréat en gestion de la santé ou administration des affaires

Master souhaité

Job description

Director of Credentialing and Payor Contracting

Behavioral Health Solutions -Henderson, NV, United States

Behavioral Health Solutions (BHS), a multi-state mental healthcare provider, is seeking a Director of Credentialing and Payor Contracting to oversee and manage the credentialing process for healthcare providers and lead negotiations with insurance payors. This role plays a pivotal part in ensuring the efficient and compliant credentialing of providers while optimizing reimbursement rates and terms through effective payor contract negotiations.

Job Type: Full time (M-F), salaried role, located at our Henderson, NV Headquarters.

Credentialing Management

• Oversee and guide the Credentialing team to ensure timely and accurate processing of provider credentialing and re-credentialing applications in compliance with industry regulations and organizational standards.
• Maintain accurate provider data and track MD/DO new licenses and renewals across multiple states.
• Develop, implement, and communicate credentialing policies and procedures to ensure alignment with compliance, regulations, legal requirements, and industry best practices.
• Generate and present reports on operational performance, provider credentialing statuses, and financial impacts to leadership.
• Create and maintain an internal audit process for completeness, accuracy, and compliance with quality standards and pertinent policies.
• Stay updated on changes in regulations and policies that might affect credentialing processes.

Payor Contract Negotiations:

• Lead negotiations of provider contracts with insurance payors to secure favorable rates, terms, and conditions that align with the organization's financial and operational goals.
• Collaborate with Executive and finance teams to ensure contracts comply with all applicable laws, regulations, and industry standards.
• Develop and maintain strong, productive relationships with insurance payor representatives, serving as the primary point of contact for payor inquiries, concerns, and escalations.
• Stay informed about industry trends, reimbursement rates, and changes in healthcare policies to inform contract negotiations and strategy.
• Monitor and assess the performance of payor contracts, ensuring compliance with agreed-upon terms and service levels.
• Proactively manage contract renewals and amendments, identifying opportunities for improvement and optimization.
• Review contract language to ensure compliance with regulations and organizational objectives.
• Analyze contract terms to optimize revenue generation while maintaining cost-effective practices.
• Implement strategies to mitigate contract-related risks and maximize revenue opportunities.
• Ensure timely submission of required documentation and information for contract renewals and updates.
• Perform additional tasks as required to support the organization's credentialing and payor contracting needs.

Requirements

• Bachelor’s degree in Healthcare Management, Business Administration, or a related field (Master’s degree preferred).
• 2-4 years of experience in medical credentialing; or Certified Professional Credentialing Specialist status
• 3-6 years of experience in a Credentialing Manager or similar role.
• Proven ability to lead and motivate a team while managing high-volume of new and existing providers.
• Strong communication skills and the ability to work effectively across departments.
• Experience with multi-state healthcare operations is highly desirable.
• Annual Compensation between $95,000 to $105,000, DOE.
• PTO and Paid Holidays.
• Comprehensive benefits package (Medical, Dental, Vision, Life, and more).