- Bachelor's Degree
- Master's Degree
- Revenue Cycle Management
- Communication Skills
- CPT Coding
- Dental Insurance
- Health Insurance
- Paid Time Off
- Disability Insurance
Come join a friendly and diverse team that provides quality care! Community Healthlink (CHL) is looking for a full-time (37.5 hrs/wk) Contracts and Provider Enrollment Manager at our Worcester site.
Under the supervision of the Chief Operating Officer, the Contracting and Provider Enrollment managers is responsible for third-party contract negotiation, relationship building with area health plans as well as responsibility for rate and claim volume forecasting, and third-party contract revenue projection. Relationship building with the health plans, Medicaid, DPH, BSAS and funders. Responsibilities also include accurate and timely provider enrollment and facility credentialing along with education at the clinic and senior level in areas of contracts, insurance eligibility, covered services.
Compensation based on education and related work experience, licensure and other qualifications
Health and Dental insurance (available upon starting)
Generous paid sick, personal, holiday, and vacation time
Life and Disability insurance
401k with agency contribution
Wellness activity discounts
Work related travel reimbursement
Develops, negotiates and manages complex contractual, legal and financial arrangements with area health plans to ensure that patients have superior access to the highest quality, cost-effective services.
Develops, negotiates, manages and maintains provider contracts for all practices and programs.
Leads complex negotiations and/or contracting arrangements which requires developing a sound business strategy for the financial and legal terms required for such contracting initiatives.
Leads the research development and implementation for new, creative and potentially complex reimbursement structures.
Maintains a close collaboration with Revenue Cycle Management, Finance and Clinical Vice Presidents in areas of revenue recovery activities and credentialing.
Assures that contractual arrangements meet financial budgetary targets and legal and/or regulatory compliance requirements.
Assists with revenue forecasting and projection based on claim volume, program/clinic expansion, and rate/market changes affecting covered services.
Maintains a solid understanding of Medicare and Medicaid reimbursement methodologies for service lines.
In collaboration with the COO, conducts on-going assessments of assigned networks and make recommendations for strategic initiatives, goals and objectives.
Develops and maintain strong provider partnerships.
Lead and/or participate in cross functional meetings and projects specific to provider types and serve as organization-wide expert on third-party contracted services.
Maintains excellent written and verbal communication skills with all internal and external stakeholders.
Must be self-directed, exercise initiative, discretion and seek guidance when appropriate.
Effectively and professionally represent CHL to insurance community and trade organizations.
Serve as a subject matter expert within the department and company-wide for services assigned and contracting issues in general.
Maintain high performance norms and actively participate in evaluation of own performance, establishing business goals and goals for self-development.
May supervise staff and serve as a resource and mentor for other Division employees.
Perform other related duties as assigned.
Credentialing and Provider Enrollment:
Maintains Provider Enrollments: Prepares individual provider applications, staff rosters, re-enrollment, and terminations forms and submits them to 3rd party insurance plans.
Communicates with Payers: Interacts directly with 3rd party insurance plans to insure email and package receipt, track applications, verify accurate provider status, and resolve issues.
Works with Providers: Communicates enrollment requirements, completes applications, verifies information, and obtains signatures.
Supports Credentialing: Helps with provider credentialing tasks and accesses confidential and secure federal, state, and private databases.
Maintains Data: Enters and updates provider information in electronic health records, billing system, and department databases.
Follows Timely Processes: Produces status reports and tracking spreadsheets.
Coordinates with Managers: Clarifies provider start dates, practice locations, specialty areas, privileges, and enrollment status.
Maintains Facility Enrollments: Prepares and submits facility and site applications to 3rd party insurance plans, Medicaid and Medicare.
Respects diverse views and approaches, demonstrates Standards of Respect, and contributes to creating and maintaining an environment of professionalism, tolerance, civility and acceptance toward all employees, patients and visitors.
Bachelor's Degree in business administration, public administration or a related field required. Master’s Degree preferred.
At least three years of experience working in a health care or managed care setting with a background in contract negotiations, revenue cycle management, provider enrollment and/or Finance.
Background in managed care provider contracting including, community health center, behavioral health, and/or physician groups.
Solid understanding of Medicare and Medicaid reimbursement methodologies and community health reimbursement health care services and contracting methodology.
Good understanding of community and behavioral health provider health care delivery systems.
Excellent written and verbal communication skills.
Excellent provider partnership and interpersonal skills.
Strong contract negotiation skills.
Knowledge of ICD-10 how E&M coding translates into CPT codes desired.
Results driven, able to self-direct and work independently as well as perform in a team environment.
Ability to multi-task, pay close attention to details and be flexible in a fast-paced organization.
Must be able to pass a CORI background check
Community Healthlink is an Affirmative Action/ Equal Opportunity Employer. We do not discriminate in employment and personnel practices on the basis of race, sex, gender identity, age, ancestry, disability, religion, national origin, marital status, sexual preference, political affiliation or any other basis prohibited by applicable law. Hiring, transferring and promotion practices are performed without regard to the above listed items.
If applicable, Community Healthlink shall also abide by the requirements of 41 CFR 60-300.5(a) and 41 CFR 60-741.5(a). These regulations prohibit discrimination against qualified protected veterans and qualified individuals on the basis of disability. These regulations require affirmative action by Community Healthlink to employ and advance in employment qualified protected veterans and individuals with disabilities