Merakey is seeking a Director of Contracting and Credentialing to join our Business Operations team. This position can be located at either the 4251 Crum's Mill Road Harrisburg, PA or 906 Bethlehem Pike Erdenheim, PA.
The Director of Contracting and Credentialing will lead and manage all aspects of the contracting and payer staff credentialing processes directly related to City, County, Medicaid and Managed Care payer organizations. Additionally, this position will serve as the support team for continued migration relating to commercial contracting and staff payer credentialing with commercial insurances. Responsibilities include but may not be limited to the following.
- Develops strong relationships with internal and external customers / stake holders
- Provides direction and oversees management of team and develops and implements policies and procedures for area of responsibility
- Must have an in-depth knowledge of managed care concepts, contracting terms and staff payer credentialing process
- Work requires strong negotiating skills, strong analytic and strategic thinking skills and supervisory skills
- Must plan and direct the work of a diversified staff
- Ensure the appropriate processes are in place to monitor and maintain systematic, timely credentialing and re-credentialing of staff with various payer organizations
- Develop and implement standards to ensure the accuracy of credentialing data being maintained and done across all MERAKEY payers
- Provide reports (weekly/monthly) on all aspects of credentialing process including but not limited to number of physician applications/ credentialed, outstanding issues to management
- Maintain effectiveness when experiencing major changes in work responsibilities or environment; adjust effectively to work within new work structures, processes, requirements or cultures
- Makes employment decisions for the team, seeking direction from senior leaders on more complex situations
- Knowledge and understanding of claims processing, member services and provider services as they relate to all aspects of contracting with an emphasis
- Ensures appropriate interpretation and compliance with the various accrediting (i.e. -- CAQH) and regulatory agencies, while developing and maintaining a working knowledge of the statues and laws relating to credentialing
- Strives to limit the usage of non-participating agreements, by evaluating the utilization of non-pars and the financial ability to ensure revenue is obtained
- Support other functional areas (Program Operations, QCO, Business Operations Teams, etc.) with reports and data relating to all contracts and staff payer credentialing
- Ability and willingness to travel between functional departments that are located throughout the various MERAKEY locations. (approximately 10 - 15% travel required)
MERAKEY IS PROUD TO OFFER THE FOLLOWING BENEFITS
- Work/Life Balance
- Competitive Compensation Plans
- Opportunities for professional growth and advancement
- Medical, Dental, and Vision Insurance Plans
- Flexible Spending Accounts
- Short/Long Term Disability Coverage
- Life Insurance
- 403B Retirement Plan (with company matching)
- Marketplace Savings Program
- Employee Assistance Program
- Wellness Programs
- 24-Hour Nurse Hotline
- Tuition Reimbursement
- Generous Paid Time Off (for qualifying positions)
- Stability that coincides with working for a national leader in education and human services
Merakey is a leading developmental, behavioral health and education provider offering a breadth of integrated services to individuals and communities across the country.
We leverage our size and expertise to develop innovative solutions and new models of care to meet the needs of individuals, their families, public and private healthcare funders and community partner organizations.
We recognize that complex needs require a holistic approach. With our experience, expertise and compassion, we empower everyone within our communities to reach their fullest potential.
With a rich tradition spanning 50 years with nearly 10,000 employees, Merakey provides care to over 40,000 adults and children throughout Pennsylvania, New Jersey, New York, Maryland, Delaware, Louisiana, Michigan, Texas, California, and Tennessee.
For more information on Merakey and our various divisions, please visit: www.merakey.org
Merakey is an Equal Opportunity Employer!
APPLY TODAY www.merakey.org/careers
Requisition # 53063
- Bachelor's degree required with a 3 -- 5 years' experience in commercial insurance
- Three years plus supervisory and people management experience
- Minimum of three years' experience in payer relations and/or credentialing with an insurance company, managed care organization or healthcare provider required
- Excellent written and verbal communication skills, with strong analytical and problem solving skills
- Familiarity with transaction (claims) systems as well as PC based applications such as Excel, Word, etc. preferred
- Ability to work independently and within a group, with minimal daily supervision
- Proven ability to think outside the box to perform desired results
Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled