Regional Manager of Payer Enrollment and Contracts

Planned Parenthood of the North Country New York • Full-time • Saranac Lake, New York • 13m ago

Are you ready to make a difference in the world of health care? Are you someone who values reproductive rights?

Then Planned Parenthood is the place for you.

Planned Parenthood of the North Country New York provides high-quality, affordable family planning and reproductive health care for nearly 12,000 women and men in the North Country each year no matter what. We have seven health centers throughout Clinton, Franklin, Jefferson, Lewis, and St. Lawrence counties.

At Planned Parenthood we believe that diversity in identity and perspective enriches our agency and allows us to better serve our clients. We are committed to workforce diversity and aspire to reflect the communities we serve. In support of Planned Parenthood of the North Country (NCNY)’s mission; under the direction of the Director, the Regional Manager of Payer Enrollment and Contracts is responsible for overseeing the process of enrolling healthcare providers with various insurance payers and analyzing and maintaining payer relationships as well as related issues of contract performance.

Essential Duties

- Coordinates all aspects of individual provider and facility participation with health insurance carriers under their respective delegated credentialing agreements.
- Develop and maintain relationships with payor representatives through meetings, telephone interactions and written correspondence to enhance provider enrollment, contractual obligations, and understanding of carrier system workflows and policies.
- Interprets and communicates payer polices to ensure adherence to guidelines as well as analyzing data to provide contract utilization and financial outcomes.
- Process initial and re-credentialing applications for primary source verification as set in the CVO policy and accreditation standards for PPFA.
- Provides training to Payer Enrollment and Credentialing staff as needed.
- Negotiate terms and conditions with payers to ensure favorable agreements with shared service affiliates.
- Under the direction of the Regional Director, create policies and procedures for payer enrollment and credentialing department.
- Keep Director apprised of payer enrollment and credentialing issues to mitigate risk and develop plans for payer contracting and enrollment to optimize revenue growth.
- Stays current on changing laws and regulations related to the completion of credentialing & enrollment applications and identify potential risks associated with payer contracts and enrollment processes.
- Ensures all credentialing and accreditation processes are completed in accordance with regulation, policies, and standards.
- Maintains all payer enrollment & contracts in Smartsheets, prepares reports and summaries as appropriate.
- Work closely with site management and resources to expedite completion of forms and requirements including obtaining signatures, locating required documentation, etc.
- Work collaboratively with Regional Director on other duties as assigned.
- Maintains strict confidentiality to protected health information understands HIPAA Privacy Security policies and procedures.
- Shows respect to all internal and external customers for differences in backgrounds, lifestyles, viewpoints and needs in areas such as race, gender, ethnicity, creed, sexual orientation, and others.

Required Skills and Abilities

- Three -years’ experience in healthcare related field required and knowledge in payer enrollment, contracts, health insurance and data abstracting
- Ability to organize and prioritize work and manage multiple priorities with attention to detail
- Must be flexible with the ability to work well in a team environment
- Strong analytical and problem-solving skills & ability to work independently with minimal supervision
- Strong Microsoft Office and Smartsheet experience required
- Must maintain confidentiality and exercise independent judgement
- Must maintain working relationships with clinicians, physicians, management, staff, and contacts outside the organization
- Exceptional communication skills (verbal and written), interpersonal skills and English grammar and usage
- Ability to read, interpret and apply policies, procedures, laws, and regulations

Qualifications

- High School Diploma required.
- Associate in healthcare desired.
- Notary Public certification required within one year of hire.

Physical Demands & Working Conditions

- Ability to lift ten pounds with or without an accommodation
- Bend/squat/kneel frequently
- Twist/turn constantly
- Climb stairs frequently
- Type/keyboard constantly
- Able to travel to all agency locations as assigned

$45,760 - $49,920 a year