Behavioral Healthcare Network Development and Insurance Contract Specialist

2 weeks ago

Ajmer, India NuView Treatment Center Full time

Company Overview: We are currently credentialed as an Out-of-Network (OON) provider and seek a motivated Insurance Network Specialist to help transition our facility to in-network status with various insurance companies, Employee Assistance Programs (EAPs), and other trusted behavioral health networks.


Job Responsibilities:


  • Provider Relations: Serve as the primary point of contact for insurance companies' provider relations or network development teams. Work to secure in-network contracts with relevant payers, including major insurance companies and specialized behavioral health networks.
  • Research Insurance Networks: Identify potential insurance payers that cover behavioral health services, including major providers like Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and regional/state-specific insurers. Explore opportunities to join specialized behavioral health networks (e.g., Beacon Health Options, Magellan Health).
  • Submit Applications: Manage the application process for joining insurance networks as an in-network provider. Submit required documentation, such as facility accreditation, proof of liability insurance, and NPI/TIN information. Assist in reviewing and negotiating contracts with insurers.
  • EAP Networks: Reach out to Employee Assistance Programs (EAPs) such as Cigna EAP, Optum EAP, Magellan EAP, and ComPsych. Guide the facility through the process of becoming an in-network EAP provider by submitting specialized applications and emphasizing our ability to provide high-quality employee-focused services.
  • Explore Other Provider Networks: Identify opportunities for the facility to join workers' compensation networks, Medicaid/Medicare provider networks, and other government or third-party behavioral health networks (e.g., Evernorth Behavioral Health, Tricare, Health Net).
  • Site Visits and Inspections: Coordinate with insurance companies, EAPs, and other behavioral health networks regarding any required site visits or facility inspections. Ensure compliance with safety, quality, and health standards.
  • Quality Assurance and Reporting: Maintain the facility’s credentials and oversee quality assurance processes to ensure the facility meets the ongoing requirements of insurance networks and other provider panels.


Work Timings:

The ideal candidate will be expected to align their work hours with the US Business Development and Digital Marketing teams, requiring availability from 4:30 PM to 12:30 AM IST.


Qualifications:

  • Experience in insurance contracting and credentialing, specifically in the behavioral health or healthcare industry.
  • Strong knowledge of the insurance landscape, including major health insurers, EAPs, Medicaid, Medicare, and third-party behavioral health networks.
  • Familiarity with the application, negotiation, and contracting processes for healthcare facilities.
  • Excellent communication and negotiation skills.
  • Strong organizational and project management skills.


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