BatonRougeRecruiter Since 2001
the smart solution for Baton Rouge jobs

Director, Credentialing & Payer Relations

Company: The Rome Group
Location: Baton Rouge
Posted on: May 14, 2020

Job Description:

This key leadership position is part of the Payor Relations & Network Innovation team and is responsible for the operational support and data management of contracted payor relationships.--Essential Functions:--Accountable for managing payor contract compliance, payor escalation process, payor data management and notifications, credentialing, as well as related education and reference tools.-- Directly leads and develops team members.Monitors, forecasts, and interprets financial and operational performance of private payors to determine variation from expected results, including but not limited to: contract performance, utilization of services, service line performance, DSO, aged A/R, bad debt, write-offs and additional overhead allocations required to support related lines of business.Provides knowledge, insight and informed guidance in updating agreements to achieve strategic business objectives.Identifies and resolves root causes of payor escalation projects in order to reduce contractual write-offs resulting from external payor and/or internal operational non-compliance with the contract.--Ensures 100% participation for all contracted payors via timely, accurate, and compliant credentialing and recredentialing of our agencies and proactive monitoring of changes in requirements.----Ensures payor source codes for all contracted providers are accurate and updated timely to reflect adds/terms/edits, including audits that confirm that HCHB payor source codes accurately reflect the contract, contract summary, PCR form.----Manages timely and accurate resolution of help desk tickets and seeks to provide helpful resources to reduce common inquiries.Manages proactive notifications of contract status change and provides other notices and/or educational tools regarding participation in plans and operational requirements.-- This includes webinars and conference calls as well as appropriate job aids, sharepoint and other portal resources and tools.Maintains relationships with internal stakeholders as well as with vendors, payors, and other third parties in order to enhance payor relationships.Fosters strong collaborative relationships with the regulatory team and proactively monitors for relevant payor updates, CMS updates, VA updates, state funded/Medicaid program updates, and identification or escalation of potential updates to contracts and/or systems.Proactively manages adherence to the contract renewal process, including managing process steps associated with contracting critieria compliance, obtaining required approvals, and managing notice/renewal dates.Monitors and evaluates employee performance. Holds employees accountable for the attainment of defined goals and objectives. Executes effective performance redirection when needed. Develops employees through coaching, mentoring, and formal/on the job training and development opportunities.Qualifications:--RequiredBachelor's degree in Business Administration or related field; OR equivalent work experience.Six (6+) years' experience in payor contracting support, revenue recovery or related operations.Direct experience with credentialing business processes.----Three (3+) years' prior management experience.PreferredMaster's degree in Business Administration or related field.Payor/Provider contracting experience with a health plan and/or with home health and hospice fields.

Keywords: The Rome Group, Baton Rouge , Director, Credentialing & Payer Relations, Executive , Baton Rouge, Louisiana

Click here to apply!

Didn't find what you're looking for? Search again!

I'm looking for
in category
within


Other Executive Jobs


Project Manager/Business Analyst
Description: Project ManagerBusiness Analyst Omaha, NE Minneapolis, MN Overland Park, KS New Orleans, LA CSS Staffing has an open position with our client for a Project Manager with Business Analyst Experience. Our (more...)
Company: CSS Staffing
Location: New Orleans
Posted on: 06/7/2020

Turnaround Manager
Description: Long Term Opportunity TURNAROUND MANAGER Client: Hydrogen Plant Location: This is a Traveling position following Client's TARs. Duration: 2 years or longer Schedule: 5/8s or 4/10s and then move into 7/12s (more...)
Company: UP Professional Solutions--
Location: Baton Rouge
Posted on: 06/7/2020

Director System Hosp CBO LCMC
Description: We're looking for a candidate to fill this position in an exciting company. ul li Supervises all members and facets of CBO operations for hospital services. Provides direction of CBO management by (more...)
Company: West Park Hospital-WY-US
Location: New Orleans
Posted on: 06/7/2020


Clinical Services Manager
Description: MANAGER OF CLINICAL SERVICES, NOLAAre you an experienced manager of healthcare and community workers who is looking to continue to deliver high quality care to high-need patients Are you affected by (more...)
Company: Upward Health
Location: New Orleans
Posted on: 06/7/2020

Customer Success Manager
Description: DiamondLinks is a digital marketing agency specializing in complete link building service and online reputation management firm. We are results driven, with over 15 years of combined experience in the (more...)
Company: DiamondLInks
Location: New Orleans
Posted on: 06/7/2020

Director of Operations - Industry-Leading Marine Transportation Company - High Growth, 78312
Description: Director of Operations - Industry-Leading Marine Transportation Company - High Growth -- Our client is a premier industry-leading marine transportation company that is in a mode of noble growth and expansion (more...)
Company: Truenorth Executive Search, Inc.
Location: New Orleans
Posted on: 06/7/2020

Great Clips: Assistant salon manager starkey ranch town square
Description: Assistant Salon ManagerGot shears and a winning attitude Have a yearning to earn and a desire to support other stylists Then let's talk Maybe you're a stylist who
Company: Great Clips
Location: Baton Rouge
Posted on: 06/7/2020

11B Infantryman - Management Training
Description: The Infantry is the backbone of the Army. These Soldiers fill the literal boots on the ground who are responsible for taking or holding ground during any combat operation. You'll attack, repel, and capture (more...)
Company: Army National Guard
Location: New Orleans
Posted on: 06/7/2020

Patient Services Manager
Description: TEXT TO APPLY: You can now complete your entire job application for this job via SMS text messaging br br Simply text JOB to 75000 search for the requisition ID number 383679. br br Click here (more...)
Company: Morrison Healthcare
Location: New Orleans
Posted on: 06/8/2020

District Manager
Description: WE ARE LOOKING FOR A DYNAMIC, FOCUSED AND DRIVEN MANAGER WHO IS LOOKING FOR A GREAT CAREER Currently seeking an individual to manage the daily operations of a growing, multi-unit franchise. The District (more...)
Company: HAZA Foods, LLC
Location: New Orleans
Posted on: 06/7/2020

Log In or Create An Account

Get the latest Louisiana jobs by following @recnetLA on Twitter!

Baton Rouge RSS job feeds