Credentialing and Contracting Specialist

LittleStar ABA Therapy • Carmel, IN

2d • Hybrid

About The Position

LittleStar ABA is dedicated to providing quality care to our patients, and we are looking for a compassionate and experienced Credentialing and Contracting Specialist who wants to grow with our company. The successful candidate will be responsible for negotiating, enrolling, maintaining all insurance contracts that LittleStar partners with. Key factors include assertively supporting LittleStar’s mission by developing new contracts with payers and expanding services with payers that have existing contracts to help patients with autism. The position leads the entire contract process from pre-contract through post-signature phases, and closely collaborates with the insurance team and other internal departments to ensure staff are informed of new contracts, changes to existing contracts and updates to the medical and billing policies of the payers we serve. This position will also be responsible for overseeing the successful credentialing/licensure of all clinical staff that we work with. Key factors for this are the enrolling, maintaining, terminating clinical staff with our insurance contracts. The Credentialing and Contracting Specialist will be responsible for the helping and educating all credentialed staff as they go into network with our insurance providers.

Requirements

• High School diploma or GED required; Bachelor’s degree or equivalent years of experience preferred
• 1-2 years’ experience with insurance in a medical office setting required
• Strong understanding of medical terminology.
• Results and deadline driven
• Strong attention to detail
• Excellent time management and organizational skills
• Technology competent, including Microsoft Office, email and Internet
• A positive team player and energetic professional
• Strong organizational habits with attention to detail and accuracy
• Good time management skills along with the ability to manage multiple tasks
• Ability to analyze/solve problems and work in a fast-paced environment
• Strong communication skills with ability to communicate appropriately given the circumstances of the situation and audience involved
• Discretion in matters that need to remain private
• Ability to work with a variety of people, both internal and external
• Must successfully pass the initial and updated criminal history, background, and record checks, which includes driving history checks.
• During times of high rates of COVID transmission, may be required to wear appropriate Personal Protective Equipment (PPE), as provided by LittleStar, where physical distance cannot be attained.

Responsibilities

• Responsible for credentialing all providers in the practice. This includes Commercial, Medicaid applications and Managed Care credentialing for all providers.
• Checking eligibility and benefits verification.
• Follow up on missing billing
• Responsible for credentialing facilities with insurance carriers.
• Develop, negotiate, and maintain contracts with all payers, e.g., insurance companies, MCEs, and government programs. This includes researching territories to identify gaps with our payer base.
• Facilitate the approval process of all contract documents from pre-contract through post- signature phases.
• Responsible for the accuracy of supporting documentation for contracts and completing documents accurately.
• Develop and maintain processes that provide timely notification of critical contract events (e.g., renewals, termination and due dates contained within the agreements).
• Maintain existing relationships with contracted providers. Ensure contractual language is kept current; evaluate fee schedule on a yearly basis to identify possible opportunities for additional covered services, medical policy changes and reimbursement.
• Coordinate and communicate contractual terms to the billing department; ensure staff is informed of changes in medical policy & billing policies.
• Conduct on-going assessments of assigned networks and make recommendations for strategic initiatives, goals, and objectives.
• Develop and maintain periodic, e.g., bi-weekly, reports on the status of all contracts and credentialing.
• Assure accurate data entry of contract specifications and terms into database and completeness of all contracting processes.
• Accountable for investigating the contracting/credentialing process with new private and government payors.
• Maintain excellent written and verbal communication with all internal and external people.
• Assist with all contracting administration and projects, as needed.
• Meets with providers to gather, review, and provide guidance on completion of complete credentialing packets. Also, coordinates the accurate input of physician information into CAQH and Medicaid and NPI database.
• Continuously verify the status of provider licenses, and specialty certificates.
• Help clinical staff to obtain licensure as required
• Complete various provider applications and track the status of applications once submitted.
• Maintain provider files for credentialing purposes.
• Regularly updates clinical team relevant information and sends to all payers.
• Contact appropriate organizations upon hiring of new providers.
• Maintain rosters with insurance companies LittleStar contracts with.
• Update the appropriate departments of on the status of providers credentialing on Managed Care/ Insurances.
• Coordinate and manage follows up with each payer to completion of group/providers credentialing and enrollment.
• Corresponds with providers, staff, and network provider relations staff to coordinate/confirm network provider participation; communicates provider enrollment information and status
• Builds and maintains relationships that nurture insurance provider partnerships.
• Maintains the stability and reputation of LittleStar ABA by complying with legal requirements
• Contributes to team effort by accomplishing related results as needed.
• Maintain confidentiality of center fiscal information.
• Maintain client confidentiality per LittleStar ABA policy and HIPAA Privacy Rule Regulations.
• Act as a positive role model for all staff, families and children working with LittleStar ABA and model a high standard of reliability, accuracy, integrity, and professionalism.
• Work to positively impact team spirit and overall morale
• Adhere to all LittleStar policies and procedures
• Perform other duties as assigned by supervisors

Benefits

• Three options for medical and two options for dental (50% paid by LittleStar). Vision (100% paid by LittleStar)
• Generous paid time off, 15 days for first year of employment and another day added for each subsequent year
• Nine paid holidays
• 401k with company match
• This position is eligible to work from home up to 60% of the time
• Healthy work life balance, hours are typically Monday through Friday 8ish to 4:30ish with some flexibility

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 101-250 employees