Hiring Manager-Credentialing and ATL

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HealthRecon Connect LLC provides technology-enabled Revenue Cycle Management (RCM) solutions to US healthcare providers. We leverage over 30 years of deep domain expertise, cutting-edge analytics as well as machine learning, Artificial Intelligence and Automated workflows to help improve cashflow, patient outcomes and enable peace of mind for our clients.

We are currently looking for an individual with strong business acumen in US healthcare (Revenue Cycle

Management) to fill the role of Manager Credentialing. The role holder will work closely with the Operational leadership team to solidify Credentialing as a service offering within our overall portfolio.

The role will focus on collaboration and transparency with all key stakeholders within HRC, service lines and

operations, physician, and hospital revenue cycle teams to develop and execute payer contract strategies. The

role holder will assist with payer contract, reimbursement and compliance issues and concerns, and lead the

overall governance, policies, goals, and projects of the revenue cycle activities under purview.

Open Position : Manager - Credentialing

Role & responsibilities :

Build Credentialing and Payer Contracting capability within the overall operations team, including selection and training of team members, creating process manuals and operational key performance

indicators

• Assist in the creation and provide support in the execution of a comprehensive payer contracting strategy
• Supervise and direct deliverables of the team, ensuring the team negotiates, monitors, and maintains the contract portfolio and payer relationships
• Develop and monitor contract negotiation schedules, timelines, contractual deadlines, and annual pricing renewals
• Work with Operational leaders to lead the full contract negotiation/re-negotiation cycle from assessment and identification of contract opportunities through implementation of the contract;

negotiating and managing complex and innovative payer contracts striving to maximize revenue and maintain competitive reimbursement rates

• Develop and maintain relationships with the payers as the primary contracting lead serving as a

resource for operational leaders and manage payer interactions from a contracting, value-based care,operations, and provider relations standpoint

• Lead, support and facilitate governance of payer contracting activities
• Monitor system interfaces for data timeliness and accuracy. Report missing and inaccurate data or apparent inconsistencies in data to appropriate departments when discovered for correction.
• Develop robust financial business analytics to monitor and manage the expected payment and financial margins for the business with the goal of revenue optimization
• Review, redline, and negotiate FFS contract language for payers alongside HRCs legal counsel
• Communicate with clients direct as required

Preferred candidate profile

Bachelor's Degree in degree in Finance, Business Healthcare Administration, or another closely related field, required. Master's Degree preferred.

• Minimum 10 years' experience in large healthcare systems in contract modelling, analytical service development and execution, and coding analytics in a progressively responsible management role.
• Minimum 10 years' experience in payor contracting and payor contract administration, including negotiation and proposal evaluation.
• Demonstrated proficiency with varied data analysis software, database software, spreadsheet software, database conversions.
• Detailed knowledge of hospital and physician complex reimbursement methodologies including FFS and value-based care (VBC) risk reimbursement structures including Medicare and Medicaid terms. Demonstrated experience in being responsible for large groups of employees in a complex, outsourced RCM operational setting
• Proven expertise in working across geographical locations, within KPI, SLA driven environment
• Strong executive presence, including communication skills that enable appreciation of others perspectives and the ability to offer compelling insights and recommendations
• Strong analytical capacity
• Excellent oral and written communication skills and be able to communicate effectively with all levels of management
• Familiarity with the provider market and competitive landscape and demonstrated experience building and maintaining relationships with payer partners strongly preferred
• Excellent understanding of contract language and rate terms, physician and hospital coding and billing, claims forms and claim payment methodologies, payer EOBs, and insurance laws
• Experience with governmental programs related to Medicare, Medicaid managed care and Medicare Advantage highly desirable.

Work Week:

Monday to Friday

Shift:

Night: 7:30 PM 4:00 AM

Other Features:

Full-time

US calendar applicable

Open Position : Assistant Team Lead - Credentialing

Roles and Responsibilities :

• Ensure and plan effective ways of managing the volume, accordingly in terms of the availability of volume and any additional agents are benched or moved to QA function etc.
• Develop a Credentialing Plan for the assigned client portfolio and present it to the leadership and counterparts from clients.
• Monitor whether team submit and/or follow up on credentialing applications before timely filing limits exceeded and provide necessary feedback to the team as appropriate.
• Exercise Root Cause Analysis on rejected credentialing applications of assigned clients and provide feedback to the leadership and clients.
• Maintain expected turnaround time of respective clients
• Discuss with the reporting manager on effective FTE planning, Allocation, Utilization and measure quality and quantity of the assigned work
• Ensure team follow up on In-Process credentialing applications in a timely manner.
• Ensure to respond back to internal e-mails within the shift time, and for External e-mails to be responded within the client TAT.
• Enforce company regulatory standards to ensure the area of responsibility is in compliance with HIPPA and ISO standards.
• Ensure all client related queries are resolved within the given TAT and be overall accountable for the assigned account.
• Ensure the team achieve Credentialing application approval rate as expected
• Daily and weekly assigned reports to be shared within the given timelines.
• Ensure SOPs (Standard operational procedures) are developed according to the required standard and requirement, and monitor consistency and timely updates and share with MO for final approval.
• Conduct random QA on a percentage decided by the management.
• Support the Manager in conducting employee evaluations according to the set time frames and in an objective manner.
• Conduct On The Job Training (OJT) to team members when necessary.
• Conduct or allocate personnel to train new comers on the job specific functions.
• Ensure that team members adhere to the company values.

Preferred Candidate Profile :

• Credentialing TAT
• Assigned payer approval rate to be maintained after 30 days.
• Daily credentialing targets
• Accuracy of 98% of communications with insurance companies and gathered feedback.
• Good written and verbal communication skills
• Excellent interpersonal & leadership skills

* Ability to work under pressure with high level of perseverance .

At least 4 years of total experience | 4-5 years of RCM experience including at ATL level

Work Week:

Monday to Friday

Shift:

Night: 7:30 PM 4:00 AM

Other Features:

Full-time

US calendar applicable

Interested candidates kindly apply and send us your updated resume to " "