Contract and Credentialing Administrator

Infucare Rx Inc on behalf of itself and its subsidiaries• TX, US, TX

About The Position

InfuCare Rx is a leading home infusion provider accredited by URAC and ACHC offering a specialized approach to caring for patients in need of IV therapy and specialty pharmacy services in the homecare setting. We have created an ethical, team oriented, and quality work environment for our employees that cultivates achievement and success. Job Summary: The Contract and Credentialing Administrator will facilitate all phases, contract, initiation/renewal paperwork to include maintenance of documentation and tracking of same. The successful candidate will be detail oriented in monitoring required communication, collateral materials and interaction to ensure licensing, legal and regulatory requirements are in compliance. Effective/timely/detailed interaction with local, state, and national oversight bodies as well as managed care payors and other stakeholders is essential for success. The successful candidate will perform all duties in accordance with company policy/procedure, state professional standards, and other applicable regulatory requirements.

Requirements

Bachelor’s degree required, equivalent education/experience may be considered.
Minimum (3) years’ experience in payor relations or equivalent experience relevant to position as determined by manager.
Experience in credentialing, contract review or other relevant experience with Payor credentialing and recredentialing.
Experience and proficient with Microsoft Suites (Outlook, Excel, Word, PowerPoint).
Experience working for a national or regional payor or managed care entity.

Nice To Haves

Experience working in the acute or specialty infusion pharmacy industry a plus.

Responsibilities

Facilitate all phases of contract initiation/renewal paperwork, including maintenance and tracking of documentation.
Monitor required communication, collateral materials, and interactions to ensure compliance with licensing, legal, and regulatory requirements.
Interact effectively and in a timely manner with local, state, and national oversight bodies, managed care payors, and other stakeholders.
Organize and mobilize all sensitive information from diverse internal/external sources.
Organize and maintain a contracting database.
Work with Regional Directors of Managed Care (RDMC) to efficiently complete credentialing and re-credentialing payor requirements.
Create, maintain, and utilize an ID.me account as part of job duties, including completing identity verification and using the platform to securely access systems, applications, or services.
Work with the National Director of Contracts & Strategy to keep all Medicare and Medicaid enrollments up to date.
Establish and maintain an efficient document control system, including organizing, categorizing, and indexing both physical and electronic documents.
Review all contract language with RDMC’s, providing contract guidance and support.
Monitor reportable actions and effectively communicate necessary information in proper format to regulatory bodies, states, payors, or other entities.
Support organizational & departmental policies & procedures.
Handle company information with appropriate sensitivity & safeguards to ensure confidentiality & right to privacy, in compliance with HIPAA regulatory requirements.
Contribute to team effectiveness by supporting, promoting & applying best practice standards of conduct.
Exhibit flexibility when work assignments need to be adjusted to meet service, delivery, and workload needs of the team.
Identify, develop & adapt new policies and practices that improve quality of work.
Understand and comply with Healthcare regulatory environment and HIPAA Laws.
Other duties as assigned by management.