Payer Strategy & Credentialing Manager

Join Max Surgical Specialty Management, an innovative leader in the healthcare industry, as we embark on an exhilarating journey of growth and expansion. We're on the lookout for a Payer Strategy & Credentialing Manager to join our team at our Hackensack, New Jersey office with the opportunity to work hybrid, offering the perfect balance of remote flexibility and in-office collaboration!

The Payer Strategy & Credentialing Manager reports directly to the Chief Operating Officer and works cooperatively with MAX’s executive team, departmental leaders, and partner surgeons. S/he is primarily responsible for maximizing UCR fees, negotiating and optimizing third party payor rates, and assuring surgeon credentialing to maximize reimbursement for surgical services. S/he will be expected to effectively partner with internal and external stakeholders and vendors, set clear and defined project goals, lead, or contribute to payor strategy and credentialing special projects, and empower staff in a collaborative manner that achieves overarching business goals. S/he will be accountable for delivering timely results while keeping projects within the scope of budgeted expense.

What You'll Do:

• Ensures effective completion of annual UCR fee analysis for all MAX practices
• Update all UCR fee changes in platform EMR-PMS systems, and effectively communicate changes through Revenue Cycle and Operations teams
• Applies key analysis and negotiation results of UCR fee changes to MAX annual operational budget process, while updating and tracking business impact accordingly
• Leads third party analysis of all managed practice(s) & future partner practices under LOI inclusive of UCR fee analysis, demographics, and payer related opportunities
• Execute SOW review and engages third parties in special payer related projects
• Organizes, tracks, and leads third party support team in all projects tied to fees, rates, negotiations, and credentialing on an ongoing basis
• Ensures effective practice level surgeon credentialing and re-credentialing, performs annual reviews of credentialing status, recommending drop/adds when appropriate
• Manages multiple databases, insurance portals, and surgeon specific credentialing data bases
• Effectively scales and administrates the Credential-My-Doc system across all MAX surgeons & practices to create efficiency in credentialing process
• Performs risk/benefit analysis of surgeon participation in networks, using data to make recommendations or drive decisions when appropriate
• Works interdepartmentally to ensure all surgeon “new hires” are effectively credentialed and strategically positioned to maximize reimbursement for services
  
  

What You'll Bring:

• Bachelor’s degree in business or a related field preferred but not required
• Oral surgery and payer strategy & credentialing experience expected
• Meticulous, initiative-taker, able to multi-task and communicate across functions
• Exhibits sound judgment, prioritization, and decision-making skills
• Energetic, eager to tackle new projects, and comfortable with high-level Executives
• A collaborator with a resourceful, can-do attitude that thrives in a demanding environment
• Strong organization, time-management, verbal, non-verbal, and written communication skills
• Must have a valid driver’s license, reliable transportation
• Initiative-taking and purposeful with the ability to work independently and as part of a team
• Technical proficiency in Microsoft Office & Excel
  
  

About MAX-SSM:

At MAX-SSM we are dedicated to optimizing patient outcomes through personalized care, cutting-edge technology, and unwavering professional integrity. By partnering with esteemed practices such as Riverside Oral Surgery, Oral Surgery Group, Coastal Oral Surgery, Vermont Oral Surgery Associates, Northern Vermont Oral Surgery, New England Oral Surgery, New York Oral Maxillofacial & Implant Surgery, Lititz Oral Surgery, Fairfield Oral Surgery, and Begley Oral and Maxillofacial Surgery, we ensure that every patient receives exceptional care, every time.

Integrity-driven. Patient-focused. Experience the difference at www.max-ssm.com.

MAX Surgical Specialty Management is an equal opportunity employer committed to providing fair employment opportunities regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, genetic information, marital status, veteran status, or any other legally protected characteristic. We welcome diversity and encourage applicants from all backgrounds. Our inclusive environment values and empowers every employee to contribute to our mission. 

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