Payer Contracting & Credentialing Analyst
Naples Comprehensive Health - NCH, Naples, FL, United States
DEPARTMENT: 68221 - Business Office NCHHG
LOCATION: 1100 Immokalee Road, Naples, FL, 34110
WORK TYPE:
WORK SCHEDULE: 8 Hour Day
DEPARTMENT: 68221 - Business Office NCHHG LOCATION: 1100 Immokalee Road, Naples, FL, 34110 WORK TYPE: WORK SCHEDULE: 8 Hour Day
About Nch
NCH is an independent, locally governed non-profit delivering premier comprehensive care. Our healthcare system is comprised of two hospitals, an alliance of 700+ physicians, and medical facilities in dozens of locations throughout Southwest Florida that offer nationally recognized, quality health care.
NCH is transforming into an Advanced Community Healthcare System(TM) and we’re proud to: Provide higher acuity care and Centers of Excellence; Offer Graduate Medical Education and fellowships; Have endowed chairs; Conduct research and participate in national clinical trials; and partner with other health market leaders, like Hospital for Special Surgery, Encompass, and ProScan.
Join our mission to help everyone live a longer, happier, healthier life. We are committed to care and believe there's always more at NCH - for you and every person we serve together. Visit nchjobs.org to learn more.
Job Summary
The Managed Care Contracting Analyst is responsible for managing the contracting for all governmental and third party payer contracts to include provider enrollment, credentialing, data mining of payer reimbursement rates and revenue integrity for NCH Physician Group. The Analyst will function as a liaison to NCH Health System Department of Reimbursement and Revenue Cycle Oversight performing contract language review and reimbursement analysis to facilitate the negotiation of contracts and favorable reimbursement rates. The Analyst will be responsible for revenue recovery analysis by reviewing zero balance managed care accounts for insurance underpayments in a timely manner to recover monies associated with managed care contracts for NCH Physician Group.
The goal of the position is to provide NCH Physician Group Revenue Cycle Department with managed care contracting data for the future, perform timely and successful credentialing and provider enrollment with managed care and third party contracts, optimize reimbursements in an ever changing environment, recover monies and underpayments as identified on zero balance accounts, report trends to Director of Revenue Cycle Operations, Chief Financial Officer and Chief Administrative Officer and to hold all parties accountable to the provisions and terms in accordance with the contractual guidelines. The Analyst promotes and enhances good communication and positive working relationships between the Physician Group Administration and the medical staff.
Essential Duties And Responsibilities
Other duties may be assigned.
Oversee the development, deployment and responsibility of complex programs, and processes for process improvement regarding provider enrollment, credentialing, contract management, and revenue recovery and revenue integrity. Develops and maintains NCH Physician Group Central contract database of all government and third party payer contracts, to include all contract attachments, fee schedules and other addendums. Develops and maintains a system for ongoing validation of 100% accuracy of data stored in CAQH, NPPES, PECOS, and EDI enrollment systems. Works with NCH Physician Group Revenue Cycle leadership to ensure all departmental policies and procedures are up to date and accurate based n payer contractual or regulatory requirements. Review all payer contracts to identify and determine reasonable contract terms and conditions with third party managed care payers. Responsible for credentialing of NCH Physician Group facilities for governmental and third party payers to include managed care contracting compliance requirements. Coordinates and provides administrative support for the payer credentialing process (initial provider enrollment and re-enrollment). In the absence of the Credentialing Coordinator, performs all assigned tasks and responsibilities for this position as outlines in the job description. Plans, develops and provides for supporting provider enrollment documentation for NCH Physician Group departments/committee meetings. Ensures and maintains accurate, current demographic date for all providers of the NCH Physician Group. Review, identify and assure that zero balance account underpayment and denial discrepancies are collected timely and accurately. Review weekly denial activities and identify areas for continues process improvement that will further decrease new denials and loss of related revenue. Compile payer issues escalated by complex denial and underpayment resolutions staff and report to Director and Revenue Cycle Managers. Coordinate with department Director and Revenue Cycle Mangers on contract issues related to underpayment and denial discrepancies. Analyze insurance denial trends identified in the revenue cycle. Perform routine analysis of reimbursement rates and revenue integrity. Develop and provide monthly reimbursement and credentialing reports and submit to NCH Physician Group leadership. Provide education and training to revenue cycle department employees on payer contracting and credentialing requirements. Present education in department focus groups and monthly staff meetings. Assists with internal training of NCH Physician Group managers, providers and staff of any changes related to provider enrollment or payer contracting requirements. Demonstrates the ability to foster and perform in a team-building environment. Screen, interview and participate in the hiring of new employees. Work with department and system leadership among others on process improvement opportunities. Guide individuals and group toward desired outcomes, setting high performance standards and delivering leading quality. Identify, organize and communicate project goals, schedules, responsibilities, progress and performance in all areas of assigned responsibility. Perform all work in a professional manner with the utmost discretion and strict confidentially.
Education, Experience And Qualifications
Minimum of Associate’s Degree in healthcare administration, business administration or related field with 3 year of experience in medical credentialing and/or provider enrollment OR High School/GED with 6 years of experience in medical credentialing and/or provider enrollment required. Advanced knowledge and understanding of provider enrollment requirements to ensure regulatory compliance including but not limited to CAAQH, NPPES, PECOS, JCAHO, and NCQA standards, through ongoing review. Intermediate computer knowledge: Uses Microsoft Word, Excel, Outlook, and Windows.
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DEPARTMENT: 68221 - Business Office NCHHG LOCATION: 1100 Immokalee Road, Naples, FL, 34110 WORK TYPE: WORK SCHEDULE: 8 Hour Day
About Nch
NCH is an independent, locally governed non-profit delivering premier comprehensive care. Our healthcare system is comprised of two hospitals, an alliance of 700+ physicians, and medical facilities in dozens of locations throughout Southwest Florida that offer nationally recognized, quality health care.
NCH is transforming into an Advanced Community Healthcare System(TM) and we’re proud to: Provide higher acuity care and Centers of Excellence; Offer Graduate Medical Education and fellowships; Have endowed chairs; Conduct research and participate in national clinical trials; and partner with other health market leaders, like Hospital for Special Surgery, Encompass, and ProScan.
Join our mission to help everyone live a longer, happier, healthier life. We are committed to care and believe there's always more at NCH - for you and every person we serve together. Visit nchjobs.org to learn more.
Job Summary
The Managed Care Contracting Analyst is responsible for managing the contracting for all governmental and third party payer contracts to include provider enrollment, credentialing, data mining of payer reimbursement rates and revenue integrity for NCH Physician Group. The Analyst will function as a liaison to NCH Health System Department of Reimbursement and Revenue Cycle Oversight performing contract language review and reimbursement analysis to facilitate the negotiation of contracts and favorable reimbursement rates. The Analyst will be responsible for revenue recovery analysis by reviewing zero balance managed care accounts for insurance underpayments in a timely manner to recover monies associated with managed care contracts for NCH Physician Group.
The goal of the position is to provide NCH Physician Group Revenue Cycle Department with managed care contracting data for the future, perform timely and successful credentialing and provider enrollment with managed care and third party contracts, optimize reimbursements in an ever changing environment, recover monies and underpayments as identified on zero balance accounts, report trends to Director of Revenue Cycle Operations, Chief Financial Officer and Chief Administrative Officer and to hold all parties accountable to the provisions and terms in accordance with the contractual guidelines. The Analyst promotes and enhances good communication and positive working relationships between the Physician Group Administration and the medical staff.
Essential Duties And Responsibilities
Other duties may be assigned.
Oversee the development, deployment and responsibility of complex programs, and processes for process improvement regarding provider enrollment, credentialing, contract management, and revenue recovery and revenue integrity. Develops and maintains NCH Physician Group Central contract database of all government and third party payer contracts, to include all contract attachments, fee schedules and other addendums. Develops and maintains a system for ongoing validation of 100% accuracy of data stored in CAQH, NPPES, PECOS, and EDI enrollment systems. Works with NCH Physician Group Revenue Cycle leadership to ensure all departmental policies and procedures are up to date and accurate based n payer contractual or regulatory requirements. Review all payer contracts to identify and determine reasonable contract terms and conditions with third party managed care payers. Responsible for credentialing of NCH Physician Group facilities for governmental and third party payers to include managed care contracting compliance requirements. Coordinates and provides administrative support for the payer credentialing process (initial provider enrollment and re-enrollment). In the absence of the Credentialing Coordinator, performs all assigned tasks and responsibilities for this position as outlines in the job description. Plans, develops and provides for supporting provider enrollment documentation for NCH Physician Group departments/committee meetings. Ensures and maintains accurate, current demographic date for all providers of the NCH Physician Group. Review, identify and assure that zero balance account underpayment and denial discrepancies are collected timely and accurately. Review weekly denial activities and identify areas for continues process improvement that will further decrease new denials and loss of related revenue. Compile payer issues escalated by complex denial and underpayment resolutions staff and report to Director and Revenue Cycle Managers. Coordinate with department Director and Revenue Cycle Mangers on contract issues related to underpayment and denial discrepancies. Analyze insurance denial trends identified in the revenue cycle. Perform routine analysis of reimbursement rates and revenue integrity. Develop and provide monthly reimbursement and credentialing reports and submit to NCH Physician Group leadership. Provide education and training to revenue cycle department employees on payer contracting and credentialing requirements. Present education in department focus groups and monthly staff meetings. Assists with internal training of NCH Physician Group managers, providers and staff of any changes related to provider enrollment or payer contracting requirements. Demonstrates the ability to foster and perform in a team-building environment. Screen, interview and participate in the hiring of new employees. Work with department and system leadership among others on process improvement opportunities. Guide individuals and group toward desired outcomes, setting high performance standards and delivering leading quality. Identify, organize and communicate project goals, schedules, responsibilities, progress and performance in all areas of assigned responsibility. Perform all work in a professional manner with the utmost discretion and strict confidentially.
Education, Experience And Qualifications
Minimum of Associate’s Degree in healthcare administration, business administration or related field with 3 year of experience in medical credentialing and/or provider enrollment OR High School/GED with 6 years of experience in medical credentialing and/or provider enrollment required. Advanced knowledge and understanding of provider enrollment requirements to ensure regulatory compliance including but not limited to CAAQH, NPPES, PECOS, JCAHO, and NCQA standards, through ongoing review. Intermediate computer knowledge: Uses Microsoft Word, Excel, Outlook, and Windows.
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