Coloplast Coral Springs , FL 33065
Posted 2 weeks ago
Responsible for supervising, planning and directing the Credentialing and Payer Relations processes. Will oversee all credentialing and payer relations activities, including business licensing, regulatory and accreditation activities, implementation and management of all insurance contracts (both government funded and third-party) and price table maintenance. Will work with leadership to ensure that team priorities are aligned with Comfort Medical Leadership Team (CMLT) objectives.
Major Areas of Accountability
Leadership and team managment-
Accomplish results by communicating expectations, planning and properly coaching and mentoring team members
Collaborate with HR to recruit required staff positions as well as train and orient the corresponding hires to their job function
Will own the company enrollment process with both governement funded and third-party payers and will work to minimize any interuptions for all enrollments
Will own the contract implementation and price table management process and will work to ensure such processes reduce unanticipated revenue adjustments
Provide team leadership and guidance to improve efficiency & effectiveness of team processes
Provide project leadership that ensures adherence to regulatory guidelines as change occurs
Assist in preparing for recurring meetings with key stakeholders to ensure all affected departments are informed of the progress/challenges being made and where improvements should be made
Job Duties-
Manage provider credentialing and re-credentialing applications for government-funded and commercial insurance payers; monitor applications and follows up as needed
Conduct periodic reviews to ensure proper adherence to state licensing and state registration requirements
Maintain and ensure the good standing of the company's Surety Bonds and state registration and its annual Secretary of State (SOS) reports and/or filings
Manage the setup of electronic claims, ERA and EFT with insurance companies
Manage and ensure the correct standing of contracted and non-contracted fee schedules in the company's Brightree database
Work with leadership to maintain an act of accreditation readiness and oversee any accreditation processes as it relates to the organization
Maintain and assist with the implementation of the policies and procedures, including Standard Operating Procedures required by Comfort Medical as a covered entity
Oversee the analysis, maintenance, and communication of records required by law or local governing bodies, or other departments in the organization
Assist with the implementation of new technologies, tools and system applications, as may be applicable, that have the ability to increase production and streamline processes or procedures
Observe legal and ethical guidelines for safeguarding patient and company confidentiality (HIPAA) and ensure that staff is in compliance with HIPAA and PHI regulations
Meet individual, departmental, and company goals
Other duties as assigned
Basic Qualifications
Bachelor's degree or equivalent
Minimum of 5 years' experience in credentialing, licensing, or similar role
Excellent written and verbal communication skills
Ability to work successfully as an individual and team contributor
Strong contract, financial, and business acumen and excellent strategic business understanding
Ability to clearly articulate in both oral and written format
Comfort Medical employees are required to conduct business to the highest ethical and professional standards; comply with applicable laws and regulations, the Advamed Code of Ethics on Interactions with Healthcare Professionals, and company policies.
Preffered Qualifications
Knowledge of Medicare, Medicaid, commercial insurers, related regulations, billing codes, specifically of diagnostic and procedural terminology, ICD and CPT/HCPCS coding systems, licensing and compliance rules, as well as audits
Working knowledge of Brightree or other similar DME business management software
Able to effectively communicate with all levels and areas of the organization, leading multiple projects and manage deadlines; proficient in the English language
Willingness and ability to travel, including overnight - up to 20%
Comfort Medical provides an extensive selection of name brand catheter and ostomy supplies to thousands of customers nationwide. Our attention to detail, unmatched customer service, and dedication to helping our customers live happier, healthier lives are just a few of the many reasons we are one of the fastest growing catheter and ostomy supply companies in the nation!
Comfort Medical employees are required to conduct business to the highest ethical and professional standards; comply with applicable laws and regulations, the Advamed Code of Ethics on Interactions with Healthcare Professionals, and company policies.
Comfort Medical is committed to a policy of Equal Employment Opportunity (EEO) which means we employ and promote individuals based on their merits, regardless of race, color, religion, sex, national origin, age, disability, veteran status, pregnancy, sexual orientation, gender identity or expression, genetic information, marital status, citizenship status, status with regards to public assistance or any other protected classification.
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Coloplast