Director / VP of Contracting & Credentialing

5 - 7 years experience  • 

Salary depends on experience
Posted on 03/20/18
Machesney Park, IL
5 - 7 years experience
Salary depends on experience
Posted on 03/20/18

Job Details

Description

The Director/VP, Contracting and Credentialing is responsible for the oversight of all managed care contract coordination activities as related to internal and external business. In addition; this individual is responsible for the oversight of all provider credentialing activities for internal and external customers.

  • Position can be filled at a Director or VP level depending on candidate's experience. 

Responsibilities:

Team Leadership:

  • Manage the insurance contracting team and provider enrollment/credentialing team, to include recruiting, onboarding, setting direction, assisting with problem resolution, and providing mentoring, coaching and feedback to team members on process improvements, commitments, obstacles, and metrics.
  • Develop and implement department processes, training, and policies, incorporating best practices, lean process, and industry standards
  • Understand the lean process and facilitate lean meetings with contracting and credentialing
  • Maintain and create KPIs and other industry benchmarks and metrics to create visibility and enhance the production and success of the team
  • Utilize the call review process to provide feedback and coaching to contracting and credentialing teams

Functional Leadership:

  • Facilitate conflict  resolution with internal teams and external customers
  • Attend customer meetings, both at PV and at the customer location with CEO, COO and other PV team members
  • Research and cascade new contracting and credentialing trends and news including topics on state legislation, accreditation standards, NCQA standards, payor manuals, payor mergers, etc
  • Provide managed care expertise and support to leadership and clients as needed
  • Understand leverage points with insurance carriers, and create negotiation or re-negotiation strategies
  • Review and provide feedback on contract negotiations suggested by Contracting Specialists
  • Assist with negotiating/renegotiating contracts for best terms and rates
  • Understand the credentialing/contracting internal database and how it impacts teams cross-departmentally
  • Assist with customer training presentations and welcome call introductions
  • Represent PV at industry conference as an attendee and/or speaker on the topic of contracting process, negotiations, and provider enrollment
  • Assist billing teams with various claim denials or non-par issues related to credentialing or contracting
  • Support marketing and sales efforts through prospect phone calls, e-mails, conferences and site visits

Qualifications:

  • Strong communication and interpersonal skills necessary to interact effectively with physicians, management, staff, and external customers
  • Contract negotiation skills
  • Strong organizational and analytical skills
  • Excellent verbal and written skills
  • Function successfully in a fast paced work environment
  • Knowledge of MS Office applications, detailed knowledge and experience with Excel
  • Knowledge of managed care contracts, pay methodologies, common terms and basic coding
  • Experience with IntelliCred is beneficial

Education and Experience:

  • BA Degree in business or healthcare related field preferred
  • Minimum of 5 years of leadership experience in the healthcare revenue cycle management industry
  • Knowledge of managed care contracting and healthcare provider credentialing, with at least 3 years of experience in managed care contracting preferred
  • Managed care experience a plus

Every team member at Practice Velocity exhibits our core values:

  • Team player
  • Positive energy
  • Continuous improvement
  • Clients win

DIREC01112

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