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Senior Contracting and Credentialing Manager

2 months ago

Buffalo, New York, United States Elderwood Full time
About the Role

Elderwood is seeking a highly skilled Senior Contracting and Credentialing Manager to join our team of professionals. This is a key position that requires strong analytical and communication skills, as well as the ability to work independently in a fast-paced environment.

Key Responsibilities
  • Seek opportunities to engage new contracts for Elderwood and partnered health plans, as applicable.
  • Manage the entire contracting process from initially engaging providers to finalizing contract language and rate setting.
  • Conduct business reviews of provider contracts and coordinate with legal and other internal stakeholders to manage comprehensive reviews of new contracts and amendments.
  • Oversee the signature and countersignature contract process, and be responsible for organizing and storing fully executed agreements and contract documents for each provider in the contract management system.
  • Interface with various departments in developing contractual proposals.
  • Evaluate scenarios using data analysis, industry knowledge, and information from internal stakeholders, and present sound recommendations to senior leadership related to contracting and negotiating with providers.
  • Collaborate with other key Elderwood staff, including finance and business development, to resolve operational issues and assist with process improvement.
  • Develop and maintain reimbursement tools for organizational use.
  • Create and maintain contract status summaries and tools to keep senior leadership apprised of status.
  • Coordinate and complete external reporting to contracted health plans, including credentialing and various required reports and submissions.
  • Coordinate the management of the credentialing database and associated modules, ensuring accuracy of data and reporting.
  • Monitor critical data for extensive analysis and report generation.
  • Coordinate the management of the expirables process to ensure all provider licenses and certificates remain current, and ensure appropriate notification prior to expiration.
  • Monitor and report on turnaround times for processing of credentialing applications.
  • Drive and implement seamless protocols for gathering credentialing data from providers.
  • Define and implement processes to ensure credentialing is completed and up to date in a timely manner.
  • Oversee the presentation of provider files to the Credentialing Committee.
  • Oversee the provider monthly monitoring process.
Requirements
  • Bachelor's Degree required.
  • Minimum five to seven years of experience in a provider or health plan setting.
  • Experience in one or more of the following: credentialing, reimbursement, contract review, or data analysis.
  • Critical thinking and analytical skills required.
  • Familiarity with industry standard reimbursement methodologies, including Medicare, Medicaid, and other third-party commercial reimbursement, as well as federal and state laws as they relate to those payer payment structures.
  • Strong interpersonal and communication skills necessary to effectively work with providers and payers.
  • Proficiency in Microsoft Word, Excel, Outlook, and web-based research preferred.
  • This position requires regular interaction with residents, coworkers, visitors, and/or supervisors, and requires the ability to read, write, speak, and understand the English language at an intermediate or more advanced level.
Skills and Competencies
  • Excellent analytical and critical thinking skills.
  • Strategic thinking skills.
  • Excellent interpersonal and collaborative skills.
  • Exceptional ability to articulate, be persuasive, and assertive.
  • Outstanding verbal and written communication skills.
  • Strong listening skills.
  • Ability to evaluate scenarios with limited information, propose sound solutions, and apply problem-solving skills.
  • Highly analytical and detail-oriented with the ability to demonstrate command of details and to articulate those details at a higher level.
  • Demonstrated open-mindedness.
  • Highly organized.
  • Ability to work independently and proactively in a fast-paced, dynamic environment.
  • Able to prioritize multiple deliverables and meet deadlines.