Contracting & Credentialing Specialist

RhythMedix offers the healthcare community leading edge diagnostics which are supported by outstanding service, support, and patient care.  Our Cardiac Monitoring solutions use cellular networks to send real time medical data to a central monitoring center.  Our RhythmStar mobile cardiac monitoring system is the industry's first cloud-based, all-in-one patient monitoring solution which features a single-component, multi-modality monitor.  

Essential Responsibilities

• Responsible for credentialing activities as it relates to initial credentialing, re-credentialing, and credentials modification
• Ensures that the credentialing requirements for governmental agencies and commercial managed care insurers/networks are met and managed appropriately and timely  

• Submits and follow up on credentialing to all contracted commercial payors and government agencies timely and accurately
• Enters and maintains data in the contracting and credentialing database, according to established data entry rules and policies. Performs database queries and reports as needed.
• Ensures that demographic changes are promptly reported to all contracted managed care companies and governments agencies
• Maintains managed care contract files (paper and electronic) and department databases for contracts and credentialing
• Acts as a liaison with the VP of Payer Relations for collaboration with third-party commercial payers to provide necessary documentation and information needed for managed care contracting to proceed
• Report on performance and activities on a monthly basis
• Update and maintain contract database

Qualifications

• High School Diploma/GED required. Bachelor’s degree preferred
• Minimal five years’ experience in a managed care credentialing and contracting preferred.  Will consider candidate with professional high level administrative duties  
• Comprehensive knowledge of the managed care industry, with specific emphasis on ancillary credentialing and contracting requirements
• Ability to communicate effectively both verbally and in writing with internal staff, management, and managed care companies in order to achieve the necessary results required in the credentialing and contracting process
• Actively engages in supporting department contracting and negotiation efforts as needed
• Maintains in reportable form contract terms, rates, policy
• Participates in over and under payment reviews to determine if contracts are being honored and reports to VP of Payer Relations
• Assists internal departments, specifically the Reimbursement Team with questions and issues and offers a solution when viable  

Performs other duties and works on special projects as requested.