Contracts & Credentialing Specialist

Summary

Responsible for managing all aspects of behavioral health treatment service contract administration including specific technical knowledge regarding provider types and treatment service billing rules. Also responsible for managing all aspects of provider billing credentialing with AHCCCS, Medicare and other commercial insurance plans.

Essential Duties and Responsibilities

• Develops and manages payer specific contracts
• Oversees acquisition of provider contracts and agreements
• Manages provider AHCCCS, Medicare and Commercial Insurance credentialing
• Negotiates rates with all payers
• Evaluates ACA/ACO rules and regulations to make recommendations and assist in implementing changes
• Ensures Billing department and Enrollment department is informed regarding provider contract and credentialing updates to ensure accurate billing
• Coordinates directly with AHCCCS payers regarding contract matters and provider credentialing
• Evaluates and reports contract specific trends, CPT and ICD-10 changes and its impact on organization
• Attends the monthly AHCCCS payer data compliance meetings
• Plans and organizes quarterly subcontractor meetings
• Develops and oversees maintenance of a computerized tracking system to ensure completeness of contract files to ensure agency compliance with deliverables.
• Maintains current process documentation of job duties
• Works directly with other departments to improve processes and resolve issues
• Performs other related activities in accordance with agency growth and change

Position Requirements

Education:

• Bachelor's or Master's degree in Business Administration, Management, Organizational Management or related field 

Experience:

• Three years’ experience in contract and credentialing related work.

Additional Requirements:

• 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.

Schedule

• Monday - Friday 8a - 5p

Compensation:

• Pay Rate: $25.00 to $30.00/hour 
• Pay Comments: Hourly rate dependent of experience related to credentialing AND contract negotiation