Job Title: Payer Contracting and Credentialing Specialist

Department: Payer Strategies

Location: Grand Rapids, MI –MSO Office

FLSA Status: Non-Exempt

Manager Title: VP of Payer Relations

Work Location: Hybrid/ Onsite

About Us:

Infusion Associates is a multi-specialty infusion provider group with multiple sites across the Midwestern United States poised for rapid growth. Our sites support specialty physician services, infusion therapy, and leading-edge research on new medications for complex and rare disease states. Our service model makes it easy for patients to receive intravenous therapies 365 days a year with the support of physicians, advance practice providers, nursing, and pharmacy services. Our focus is always to provide a high-quality, low cost, exceptional patient experience at every interaction.

Position Summary:

Reporting to the VP of Payer Relations, the Payer Contracting and Credentialing Specialist holds a vital role in ensuring providers are credentialed, contracted, and active with payers in a timely manner to maintain access for our patients. This resourceful position requires adept communication and collaboration with payers, internal and external stakeholders as well as prioritizing our provider contracting and credentialing needs to ensure fair reimbursement. Responsibilities require an in-depth knowledge of payer-provider relationships, contracting, provider enrollment, and credentialing. Strong relationship, communication, analytical and evaluative skills, and the ability to participate and manage special projects or portions of projects is necessary.. Assignments may require interfacing with gathering information from a variety of stakeholders. various levels of management and internal or external executive leaders.

Essential Functions & Responsibilities:

· Establishes working relationships and collaborates with external organizations as it pertains to payer contracting, credentialing and network status. Maintains positive relationships with healthcare payers and partners.

· Gathers and maintains all contracting, provider enrollment and credentialing documentation. Obtains missing or incomplete information to accurately fulfill external provider enrollment and credentialing requests to meet critical deadlines.

· Collaborates with VP of Payer Relations to review and maintain contracts with healthcare payers and other partners. Ensures that contracts align with the organization’s strategic goals and comply with all legal and regulatory requirements.

· Manages and organizes the contracting and credentialing database while creating and implementing alerts based on contractual agreement provisions as it pertains to payer credentialing and payer network status.

· Monitors compliance with contractual obligations, regulations, and accreditation standards. Stays informed about changes in the healthcare industry, payer policies, and regulations affecting our providers.

· Tracks the status of claims escalations, ensuring timely and accurate reimbursement from payers. Collaborates with the Reimbursement Manager and Revenue Cycle team to address payment discrepancies or denials to identify trends.

· Interfaces with internal management, leaders, staff and stakeholders. Serves as a resource possessing the latitude to gather and exchange information and providing guidance and problem resolution on complex, challenging and variable situations that demand analytical, interpretive and evaluative thinking.

· Participates in defining project plans and goals. Manages and/or leads small projects or portions of projects

Knowledge, Skills & Abilities:

· Understanding of healthcare payer systems, reimbursement models and insurance policies.

· Knowledgeable in credentialing processes and procedures for payer entities across multiple states/regions.

· Exceptional communication and relationship-building skills.

· Strong attention to detail and organizational skills. Demonstrated ability to manage multiple, concurrently running projects and adapt to changing deadlines, competing priorities and unexpected assignments.

· Ability to work independently and with minimal supervision. Ability to work in a team environment providing support to multiple positions. Ability to resolve problems and complete assignments accurately and promptly.

· Proficiency with Microsoft product suite (MS Word, Excel, PowerPoint, SharePoint, etc.), financial systems/software, relational database management and business intelligence reporting tools. Ability to utilize PC-based financial tools. (i.e., spreadsheets, databases, graphics, etc.)

· Demonstrate excellent verbal and written communication skills and have the ability to communicate tactfully with department heads, managers, coworkers, payers and vendors to resolve problems and negotiate resolutions.

· Must be comfortable operating in a collaborative, shared leadership environment.

· Bachelor’s degree in business, healthcare administration, or a related field preferred.

Physical Requirements/Working Conditions:

· Mental Requirement – Ability to multitask without loss of efficiency or accuracy, including the ability to perform multiple duties from multiple sources.

· Mental Requirement – Ability to work and sustain attention with distractions and/or interruptions.

· Mental Requirement – Ability to interact appropriately with a variety of individuals including customers/clients.

· Mental Requirement – Ability to understand, remember and follow verbal and written instructions.

· Mental Requirement – Ability to work effectively and efficiently in high stress and conflict situations.

· Mental Requirement – Ability to perform under stress and/or in emergencies.

· Physical Requirement – Fine Motor Skills (pinching, gripping, etc) (Occasionally)

· Physical Requirement – Hearing (Frequently)

· Physical Requirement – Pushing/pulling (Occasionally)

· Physical Requirement – Reaching (Occasionally)

· Physical Requirement – Sitting (Frequently)

· Physical Requirement – Standing (Frequently)

· Physical Requirement – Stooping/crouching/kneeling/crawling (Occasionally)

· Physical Requirement – Talking (Frequently)

· Physical Requirement – Walking (Frequently)

· Physical Requirement – Near Vision (Constantly)

· Physical Requirement – Color Discrimination (Occasionally)

· Physical Requirement – Use of keyboard, mouse and/or computer equipment (Constantly)

· Physical Requirement – Lift up to 35 pounds without assistance (Occasionally)

· Occupational Exposure/Risk Potential – Inside office environment (Applicable)

This position is at-will, which means that either the employee or the company may terminate the employment relationship at any time, with or without cause, and with or without notice. Nothing in this job description or any other communication, whether written or oral, between the employee and the company, shall alter the at-will nature of the employment relationship.

At Infusion Associates, we are committed to a diverse and inclusive workplace and strongly encourage applicants from all backgrounds and walks of life to apply. Infusion Associates complies with federal and state disability laws and makes reasonable accommodation for applicants and employees with disabilities. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact the HR Department at 616-954-0600.  

Job Type: Full-time

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• Monday to Friday

Application Question(s):

• What is your desired compensation for this role?

Education:

• High school or equivalent (Preferred)

Experience:

• Payer Contracting: 1 year (Preferred)
• Credentialing: 1 year (Preferred)

Work Location: In person