Recovery Centers of America at King of Prussia
Position Overview: This Department is responsible for provider enrollment and contracting across multiple states. Additionally, this department supports multiple internal stakeholders including Revenue Cycle Management, Utilization Review, and Compliance functions as it relates to maintaining adherence to contractual obligations.
- Knowledge of various professional and facility-based contracting strategies and payment methodologies (e.g., P4P, value-based contracting, shared savings, etc.).
- In conjunction with internal and external stakeholders, secure executed professional & facility-based agreements in conjunction with business development and expansion goals.
- Gather, review, and submit credentialing applications, as required, for network development and management.
- Provides general support to all network development activities and support Director and other Contract team with implementation requirements.
- Strategizes with other members of the management team to ensure network management division goals are met.
- Collaborates with other departments to address and resolve operational issues as related to negotiated contracts.
- Under direction of leadership, prepares and submits requests for contract changes, provider demographic data changes, prepares rosters, and/or claims processing.
- Completes onboarding of new managed care payor contracts with internal and external stakeholders. Perform contract orientations (includes writing/updating orientation material when necessary).
- Perform duties to act as a liaison between providers, payors, and the company including investigating and resolving provider, claims, and/or, contractual issues.
- Negotiate and process single case agreements.
- Review contract language.
- Perform education and guidance to payors to ensure contracts and providers are loaded correctly and accurately.
- Receive and respond to internal and external provider related issues. Investigate and communicate provider/payor changes.
- Build fee schedules in EMR.
- Author provider/contract change requests and oversee through completion.
- Responsible for remaining educated on payor/provider policy changes by attending payor education webinars, townhalls, etc.
- Assists with credentialing applications (professional/facility based) for Medicaid, Medicare, and commercial payors.
- Perform contract orientations (includes writing/updating orientation material when necessary)
- Demonstrate excellent customer service.
- Work on special projects as needed and assist co-workers in completion of critical tasks.
- Assist those that facilitate contracts, faxes, phone calls, and research as needed in the department.
Education and Experience:
- Bachelor’s Degree Preferred
- 2 years of Provider Relations Experience
- Ability to multi-task and manage multiple competing priorities
- Demonstrate ability to work in a fast-paced environment
Work Environment: This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, and filing cabinets. The noise level in the work environment is usually moderate.
Physical Demands: While performing the duties of this position, the employee is regularly required to talk or hear. The employee frequently is required to use hands to finger, handle or feel objects, tools or controls. The employee is occasionally required to stand; walk; sit; reach with hands and arms; climb or balance; and stoop, kneel, crouch or crawl. The employee must occasionally lift and/or move objects up to 25 pounds. Specific vision abilities required by this position include close vision, distance vision, color vision, peripheral vision and the ability to adjust focus.
Travel: Travel is primarily local during the business day, although some out-of-the-area and overnight travel may be expected.