Part-time Payer Contracting & Credentialing Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Prepare and submit applications for both commercial and Medicaid organizational purposes.

• Oversee the enrollment and revalidation processes for managed care organizations (MCO).

• Monitor contracting milestones, renewals, and any outstanding requirements.

• Analyze payer contracts and fee schedules, recognizing reimbursement discrepancies and highlighting operational or financial risks.

• Manage the enrollment of organizational Type 2 NPIs and additions of service locations.

• Ensure taxonomy alignment with the appropriate levels of licensed care.

• Update relevant CAQH profiles as necessary.

• Conduct targeted reviews of behavioral health CPT and HCPCS billing practices in relation to payer policies, covered services, and fee schedule stipulations.

• Assess authorization and documentation needs.

• Investigate denial patterns and propose corrective measures to leadership.

• Research state Medicaid fee schedules, managed care reimbursement frameworks, and provider manuals.

• Compile written findings to support expansion efforts into new states.

• Summarize reimbursement insights and potential financial consequences for executive consideration.

• Maintain precise records of contracting and enrollment activities.

• Primarily work asynchronously and via email, with occasional meetings on Microsoft Teams.

⛳️ Requirements

• Minimum of three years of experience in behavioral health payer contracting, including Medicaid MCO enrollment and commercial payer contracting.

• Proficient understanding of behavioral health CPT and HCPCS codes, billing requirements for levels of care, and ASAM levels of care.

• Proven ability to interpret Medicaid fee schedules, payer policies, and contract clauses to identify reimbursement inconsistencies and operational risks.

• Excellent written communication skills, capable of delivering clear findings and actionable suggestions within specified timelines.

• Ability to prioritize tasks, manage deadlines, and exercise sound judgment within a defined focus on contracting, credentialing, and analysis.

• Experience with multi-state Medicaid is preferred.

• Background in supporting a consulting organization, management services organization (MSO), or multiple facilities is preferred.

🏝️ Benefits

• Meaningful Work: Contribute to an organization dedicated to providing ethical, high-quality behavioral health and substance use disorder treatment.

• Flexible Schedule: Enjoy the ability to work remotely for approximately 10 hours per week, primarily managing asynchronous tasks with occasional scheduled meetings.

• Professional Impact: Utilize your expertise to enhance payer relationships, ensure reimbursement accuracy, and boost financial and operational performance.

• Part-time W-2 employment.