Strategic Credentialing & Payer Relations Specialist

Blanchard-Valley-Health-System; Findlay (OH); On-site; USD 48,000 - 70,000; Full time

Job summary

BVHS is seeking a credentialing and enrollment specialist to manage government payers, commercial networks and payer databases for facilities and physicians. You will coordinate communications, enroll providers, and support billing through accurate credentialing and contract administration.

You will lead contract negotiations, maintain databases, and perform data analytics to improve efficiency, accuracy and policy compliance across managed care programs.

Qualifications

• Bachelor's degree in business or health-related field, or equivalent relevant experience.
• Excellent organization, time and work process management skills.
• Strong database management and analytical skills.
• Strong problem-solving skills and operation improvement orientation.
• Positive service-oriented interpersonal and communication skills.
• Demonstrated skills in using Excel, Word and Microsoft Access.

Responsibilities

• Leads operational projects and performs routine and special analyses and data collection projects for the Managed Care department to advance successful implementation of the managed care strategy.
• Conduct contract negotiations with specified payers. Leads contract implementation and renewal activities for all payers for BVHS entities and physicians.
• Creates, maintains and distributes timely, accurate and detailed databases for contract management and provider information to support billing and managed care.
• Manages and performs data management, reporting and analytic projects for various projects.
• Coordinates activities related to employer, provider and payers, including workshops and educational sessions to promote BVHS services.
• Maintains current knowledge base regarding governmental and commercial payer enrollment and credentialing requirements.
• Researches and intervenes to resolve systemic billing/payment issues with contracted payers related to credentialing and enrollment.
• Provides administrative support activities as needed to the managed care dept.

Skills

Organization skills

Time management

Analytical skills

Problem solving

Interpersonal communication

Education

Bachelor's degree in business or health-related field

Tools

Microsoft Excel

Microsoft Word

Microsoft Access

Job description

BVHS is seeking a credentialing and enrollment specialist to manage government payers, commercial networks and payer databases for facilities and physicians. You will coordinate communications, enroll providers, and support billing through accurate credentialing and contract administration.

You will lead contract negotiations, maintain databases, and perform data analytics to improve efficiency, accuracy and policy compliance across managed care programs.