Healthcare Contract Manager
3 weeks ago
As a key member of the CODAC Health team, the Contracts and Credentialing Specialist will be responsible for managing all aspects of behavioral health treatment service contract administration. This includes developing and managing payer-specific contracts, overseeing the acquisition of provider contracts and agreements, and managing provider AHCCCS, Medicare, and commercial insurance credentialing. The ideal candidate will have a strong understanding of contract administration, billing systems, and healthcare regulations. Additionally, they will be able to negotiate rates with payers, evaluate ACA/ACO rules and regulations, and ensure accurate billing. The Contracts and Credentialing Specialist will work closely with the Billing and Enrollment departments to ensure seamless contract and credentialing updates. This is a critical role that requires strong analytical and communication skills, as well as the ability to work effectively in a fast-paced environment.
Key Responsibilities
- Develop and manage payer-specific contracts
- Oversee acquisition of provider contracts and agreements
- Manage provider AHCCCS, Medicare, and commercial insurance credentialing
- Negotiate rates with payers
- Evaluate ACA/ACO rules and regulations
- Ensure accurate billing
- Coordinate with AHCCCS payers regarding contract matters and provider credentialing
- Evaluate and report contract-specific trends, CPT, and ICD10 changes
- Attend AHCCCS payer data compliance meetings
- Plan and organize quarterly subcontractor meetings
- Develop and maintain a computerized tracking system for contract files
- Bachelor's or Master's degree in Business Administration, Management, or related field
- Three years' experience in contract and billing systems related work
- Valid Arizona Driver's license and proof of current insurance
- Familiarity with various ethnic and cultural groups
- Intermediate to advanced computer skills using MS Office products
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