Contracting Specialist

Description:

Position Overview: Contracting Specialist

The Contracting Specialist is responsible for creating MCO Guides for clients that are signed up for Case Management services. The Contracting Specialist is the liaison between the Case Management and Contracting team to ensure a seamless transition for the clients. The Contracting Specialist reports to a Manager of Contracting.

Key Results Area

Puts forth best efforts to learn and understand the full training provided upon onboarding.

Maintain a full understanding of Guided Care software for managing contracting workflow.

Creates and maintains MCO Guides for all new Case Management facilities.

Completes MCO Guides with Network Status within 3 business days of receiving facility

information and contract copies.

Completes Reimbursement on MCO Guides within 30 days of facility signing up for services.

Best practice to complete this within 3 days. A 30 day grace period is given for instances were

you do not receive contract copies.

Assist the case management team with contracting-related questions and issued that come up during the verifications, authorization, or billing processes.

Maintains and updates Guided Care database, MCO guides, MCO Guide Processes.

Responds to client emails by EOD.

Submit forms, applications, and other requests to the credentialing team as necessary to complete credentialing requirements.

Maintain professional, timely communication with clients.

Escalate concerns related to contracting obstacles to supervisor within 48 hours. This can include but is not limited to, ongoing unresponsiveness from insurance usually after 3 follow ups are unanswered, client concerns, contract terminations.

Assist Case Management and Clients with reimbursement, claims and change of ownership processes as it relates to insurance and contracting.

Evaluate and assess personal performance on a routine basis.

Maintains Excellent attendance.

Maintains time clock, requests, and takes PTO according to HR policies.

Other duties as assigned.

Agree to uphold and practice company principles (GUIDE) in all work-related interactions.

Communicates respectfully with colleagues and leadership.

Requirements:

Minimum 1 year work experience at Guided Care

High School Diploma or GED

Independent and self-motivated.

Innovative and detail-oriented professional with strong research and organizational skills.

Thrives in a fast-paced, high-pressure environment.

Strong time management with a proven ability to meet deadlines.

Solid collaborative skills with team and clients.

Ability to work remotely and autonomously.

Ability to establish and maintain positive relationships.

Ability to communicate and exchange information and ideas so others will understand.

Demonstrate discretion, sensitivity, and ability to maintain confidentiality.

Quality camera to be used when joining internal and client meetings scheduled via Zoom or Microsoft Teams or other video meeting platforms. When participating, focus on the matter at hand. Refrains from actively performing other duties even if work-related.

Joins scheduled client meetings timely, best practice 3 minutes before meeting time, to ensure the best self and company representation.

Microsoft Office proficiency, with the aptitude to learn new programs.