Part-time Payer Contracting & Credentialing Specialist

Atlantic Health Strategies

13d•$50 - $50•Remote

About The Position

Atlantic Health Strategies is seeking a Part-time Payer Contracting & Credentialing Specialist. In this part-time, remote role, the Payer Contracting & Credentialing Specialist serves as a specialized operational partner to the leadership team. This position supports commercial and Medicaid contracting, credentialing, reimbursement analysis, and billing compliance reviews. The Specialist plays a critical role in ensuring revenue integrity, maintaining accurate payer enrollments, and identifying financial risks before they impact the organization. This is a highly analytical role requiring independent judgment. Work is primarily asynchronous and email-based, with occasional client-facing Teams meetings.

Requirements

Minimum 3 years of behavioral health payer contracting experience.
Direct experience with Medicaid MCO enrollment and commercial payer contracting.
Working knowledge of behavioral health CPT/HCPCS codes and level-of-care billing
Strong organizational, documentation, and interpersonal skills.
Ability to work independently and collaborate effectively via email and occasional Teams meetings.
Ability to maintain compliance with HIPAA and relevant behavioral health regulations.

Nice To Haves

Multi-state Medicaid experience and experience in a consulting, MSO, or multi-facility environment is highly preferred.

Responsibilities

Payer Contracting: Prepare and submit commercial and Medicaid organizational applications, manage MCO enrollment and revalidation processes, and maintain contracting trackers and renewal timelines.
Reimbursement Analysis: Review reimbursement schedules, identify rate variances, and flag contract language that presents operational or financial risk.
Credentialing Management: Manage Type 2 NPI enrollments and service location additions, ensuring taxonomy alignment with licensed levels of care, and coordinate CAQH updates.
Revenue Integrity: Conduct focused billing compliance reviews of behavioral health CPT/HCPCS codes and compare billed services against payer policy and fee schedule guidance.
Risk Mitigation: Identify authorization and documentation risk areas, analyze denial patterns, and recommend corrective actions to leadership.
Medicaid Research: Research state Medicaid fee schedules and managed care reimbursement structures, interpret provider manuals, and provide written analysis to support expansion into new states.
Performance Reporting: Summarize reimbursement impact for executive review and maintain accurate, current contracting logs.