What are the responsibilities and job description for the Division Contracts and Credentialing Specialist position at Southwest Division?
Position Summary
The Division Contracts and Credentialing Specialist leads the efforts in contract negotiations and analysis for Medicaid, managed care and other ancillary/payor source contracts as assigned of all facilities in the division in accordance with all laws, regulations, and LCCA standards. Reports to the Division Controller.
Education, Experience, and Licensure Requirements
- Bachelor's degree in business or healthcare field from accredited college (or equivalent experience)
- Five or more years experience in managed care contracting in the insurance or provider setting
- Prior healthcare experience – skilled nursing preferred
- Familiar with professional community
Specific Job Requirements
- Willing and able to travel extensively
- Excellent verbal and written communication skills
- Proficient with Word, Excel, and e-mail
- Able to multi-task
- Able to implement contracts at facility level
- Knowledgeable of managed care practices and procedures as well as laws, regulations, and guidelines governing managed care functions in long-term care
- Plan, organize, develop, implement and interpret programs, goals, objectives, policies, and procedures of the managed care department
Essential Functions
- Work closely with facilities to implement profitable managed care contracts
- Educate divisional, regional and facility staff in aspects of managed care and cost containment
- Review contracts annually and negotiate optimal rates for contract levels
- Serve as liaison between managed care organization and facilities to problem-solve issues and ensure cost-effective services are provided and favorable outcomes obtained
- Read, write, speak, and understand the English language
- Understand and follow company policies, including harassment and complaint procedures
- Practice dependable, regular attendance
- Concentrate and use reasoning skills and good judgment
- Communicate and function in an interdisciplinary team
- Sit, stand, bend, lift, push, pull, stoop, walk, and move intermittently during working hours
An Equal Opportunity Employer
