Contract and Credentialing Specialist

23 hours ago


Tucson, Arizona, United States CODAC Health Full time
Job Summary

We are seeking a highly skilled Contract and Credentialing Specialist to join our team at CODAC Health. This role will be responsible for managing all aspects of behavioral health treatment service contract administration, including provider types and treatment service billing rules. Additionally, the successful candidate will oversee provider billing credentialing with AHCCCS, Medicare, and other commercial insurance plans.

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 all payers
  • Evaluate ACA/ACO rules and regulations to make recommendations and assist in implementing changes
  • Ensure Billing department and Enrollment department is informed regarding provider contract and credentialing updates to ensure accurate billing
  • Coordinate directly with AHCCCS payers regarding contract matters and provider credentialing
  • Evaluate and report contract-specific trends, CPT, and ICD10 changes and its impact on the organization
  • Attend monthly AHCCCS payer data compliance meetings
  • Plan and organize quarterly subcontractor meetings
  • Develop and oversee maintenance of a computerized tracking system to ensure completeness of contract files to ensure agency compliance with deliverables
  • Maintain current process documentation of job duties
  • Work directly with other departments to improve processes and resolve issues
Requirements
  • Bachelor's degree in Business Administration, Management, Organizational Management, or related field
  • Master's degree in Business Administration, Management, Organizational Management, or related field
  • Three years' experience in contract and billing systems-related work
Preferred Qualifications
  • Valid Arizona Driver's license, proof of current insurance, and willingness to use personal vehicle
  • Motor Vehicle Record: no more than 2 moving violations or a license suspension in past 3 years
  • Familiarity with various ethnic and cultural groups
Skills
  • Ability to interact effectively with others
  • Intermediate to advanced computer skills using MS Office products; Project, Word, Excel, Access, etc., importing/exporting data to/from applications


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