Interim Payor Contracting, Credentialing, and RCM Manager

Coastal Health & Wellness is seeking an Interim Payor Contracting, Credentialing, and RCM Manager!  

The Payor Contracting, Credentialing, and RCM Manager is essential in overseeing the financial operations of healthcare services, ensuring the revenue cycle processes are optimized for the financial stability and sustainability of Coastal Health & Wellness. This role includes managing billing, coding, collections, and other financial components for services provided by the FQHC.

Additionally, the Payor Contracting, Credentialing, and RCM Manager is responsible for overseeing the credentialing process and managing all payor contracts. This includes developing and maintaining up-to-date credentialing policies and procedures in compliance with oversight regulations. The manager will also be responsible for handling CHW payor contracts, coordinating negotiations, and establishing terms and fees for these agreements.

We can offer you:

• Excellent Benefits; including an Amazing retirement package, Paid Time Off plans, Affordable Medical Insurance, FREE Life Insurance, FREE Long-Term Disability, FREE Parking and much more!
• Team Oriented Environment
• Salary Rate: To Commensurate with Experience

We want you to join our team of professionals!  If you meet the criteria listed below, please apply.

Required:

• Bachelor’s degree in business, healthcare, or related field
• 2 years of supervisory/management experience
• Minimum of 3 years for related payor contract management and credentialing experience.
• NextGen EPM, EHR, EDR experience is preferred.
• Understanding of medical terminology and coding & billing compliance laws, regulations, policies, and guidelines.
• Proficient in CAQH/Proview, PEMS, NPPES/I&A Management System and PECOS preferred.
• A Certified Provider Credentialing Specialist (CPCS) through NAMSS Credentialing preferred.
• Customer experience-oriented professional with demonstrated performance history and commitment.
• Excellent interpersonal, presentation and written communication skills.
• Advanced skills Microsoft suite of products; Outlook, MS Office (MS Excel & MS Word) – SharePoint experience a plus.
• Must possess or ability to readily obtain a valid driver’s license issued by the State of Texas for the type of vehicle or equipment operated.
• Must be willing and able to work evening and weekend hours if necessary.
• Must be in compliance with GCHD Immunizations policy.
• Must be in compliance with ICS training requirements.
• Must pass criminal background check and drug/alcohol screening.

An equivalent combination of education and work experience which appropriately demonstrates the knowledge, skills, and abilities to perform the above-described essential functions will be considered when hiring for this role.

Traditional Duties:

• Direct supervision of RCM team.
• Provides direction and manages the day-to-day functions within the RCM team which include medical, dental, and behavioral health encounters for uninsured as well as claims with all payors including Medicare, Medicaid, Medicaid Managed Care, and Commercial insurance companies.
• Manages staffing plans and work assignments to achieve and maintain established productivity thresholds.
• Establishes and monitors the performance aligned with billing and coding to support accurate patient information, compliant coding aligned with billing regulations, building strong front-end edits to avoid corrections and re-work.
• Manages and monitors daily work activities, NextGen tasks, worklists and evaluates, trains, and motivates the performance of RCM staff.
• Delivers comprehensive reporting to The Board, leadership, providers, and other stakeholders that communicates relevant trends, KPIs, and analytical insight into performance.
• Stays up to date with current technology, coding updates & opportunities, billing, payer requirements and federal and state regulations related to FQHC billing, coding, and collections.
• Manages staff and helps staff develop performance, training goals and objectives. Evaluates performance and recommends merit increases, promotions, and disciplinary actions to Human Resource.
• Communicates with cross-functional, internal & external teams to identify & resolve billing and/or payment issues.
• Maintains patient confidentiality and protect GCHD/CHW operations by keeping patient information confidential.
• Prepares and ensures accuracy of all reports to management, consultants, payors, and other 3rd parties, as appropriate.
• Attends all staff in-services, provider meetings, workshops, and trainings as appropriate.

Contracting, Credentialing, and RC:

• Monitor, maintain, and coordinate reviews and updates to all payor contracts for medical, dental, and behavioral health services.
• Serves as primary point of contact for all payors.
• Prepares credentialing reports for internal and external customers both monthly and as needed.
• Manage the credentialing processes with new payors as needed.
• Utilize the organization’s revenue cycle management dashboards and analytics capabilities to analyze various payors and specific plans compared to cost of services delivered, utilization rates, collection rates, timeliness of payment, and other relevant considerations to make recommendations regarding ongoing contracting and network participation decisions.
• Educate billing and clinical teams on the contracts' terms, including any value-based, outcomes-based, or alternative payment terms of contracts.
• Collaborate with the health information & analytics department on identifying mechanisms for tracking and reporting all new monitoring elements or reporting elements needed for each payor and contract.
• Collaborate with the finance, contracts, compliance, and other departments, as needed, to perform required functions, which result in the negotiation of the executed contracts as needed.
• Build and maintain collaborative relationships with provider representatives for each payor, emphasizing major payor partners, including Medicaid Managed Care Plans.
• Complete initial credentialing of the medical, dental, and behavioral health services professionals as they onboard and make updates or ongoing changes, as needed.
• Submit credentialing rosters to the centralized credentialing system(s) or payors MITS monthly according to the intervals required per payor or payor type.
• Keep credentialing rosters up to date as employees resign or transition.
• Key role in billing compliance by auditing quarterly samples, reviewing data weekly, looking at outliers, educating the team on finding and assisting with corrective plans when needed, with a special emphasis on contract compliance and clean submission rates in accordance with each payors billing rules.
• Research new service lines under consideration in alignment with the organization’s growth and strategic plan as it pertains to various payors and provides summaries of rates, models, and billing requirements for use in strategic planning and new service delivery implementations.
• Stay updated on all policy changes, billing requirements, and payor specific guidance for each payor, analyze the company's impact and communicate all changes to the necessary departments.
• Maintains a working knowledge of licensing and credentialing requirements at the local, state, and federal levels.
• Tracks and maintains all required clinical licenses.
• Tracks licensing requirements and regulations that affect the organization's policies and recommends changes to Director of Revenue Cycle Management.
• Acts as a support and back-up to the RCM department and assists with AR recovery and denial follow ups.
• Comply with HIPAA and the CHW compliance program policies and other applicable organization and departmental policies.
• Performs other duties as assigned.

Privileging:

• Verification of fitness for duty to assess to ensure all clinical staff have the physical and cognitive ability to safely perform their duties.
• Verification of immunization and communicable disease status
• Verification of current clinical competence.

Application Deadline: Open Until Filled

No Phone Calls Please

ADA/EEO/DFWP

Our Mission: Protecting and Promoting the One Health of Galveston County