HealthRecon Connect provides technology-enabled Revenue Cycle Management solutions to US healthcare providers. The company leverages over 30 years of deep domain expertise, machine learning, AI, cutting-edge analytics, and automated workflows that help improve cash flow, patient outcomes and enable peace of mind for their clients. At HealthRecon Connect, day after day, we not only hold ourselves accountable for setting and maintaining high standards, but we also passionately strive for the highest achievement, customer delight and thrive on the challenge of high expectations and commitment to excel.
HealthRecon was certified a Great Workplace by Great Place to Work® Sri Lanka for five consecutive years and was adjudged one of the 40 Best Workplaces in Sri Lanka in 2021. HealthRecon is also a Signatory Participant of the United Nations Global Compact.
We are currently looking for an individual with strong business acumen in US healthcare (Revenue Cycle Management) to fill the role of Senior Manager – Credentialing. The role holder will work closely with the Operational leadership team to solidify Credentialing as a service offering within our overall portfolio.
The role will focus on collaboration and transparency with all key stakeholders within HRC, service lines and operations, physician, and hospital revenue cycle teams to develop and execute payer contract strategies. The role holder will assist with payer contract, reimbursement and compliance issues and concerns, and lead the overall governance, policies, goals, and projects of the revenue cycle activities under purview. Due to the large volume of applications we receive, all applications will be reviewed in the order in which they were received and only the candidates short-listed for the first round of interviews will be contacted. Thank you for your understanding.
Senior Manager – Credentialing
Monday to Friday
7.30pm to 4.00am IST
US calendar applicable
- Build Credentialing and Payer Contracting capability within the overall operations team, including selection and training of team members, creating process manuals and operational key performance indicators.
- Assist in the creation and provide support in the execution of a comprehensive payer contracting strategy.
- Supervise and direct deliverables of the team, ensuring the team negotiates, monitors, and maintains the contract portfolio and payer relationships.
- Develop and monitor contract negotiation schedules, timelines, contractual deadlines, and annual pricing renewals.
- Work with Operational leaders to lead the full contract negotiation/re-negotiation cycle from assessment and identification of contract opportunities through implementation of the contract; negotiating and managing complex and innovative payer contracts striving to maximize revenue and maintain competitive reimbursement rates.
- Develop and maintain relationships with the payers as the primary contracting lead serving as a resource for operational leaders and manage payer interactions from a contracting, value-based care, operations, and provider relations standpoint.
- Lead, support, and facilitate governance of payer contracting activities.
- Monitor system interfaces for data timeliness and accuracy. Report missing and inaccurate data or apparent inconsistencies in data to appropriate departments when discovered for correction.
- Develop robust financial business analytics to monitor and manage the expected payment and financial margins for the business with the goal of revenue optimization.
- Review, redline, and negotiate FFS contract language for payers alongside HRC’s legal counsel.
- Bachelor’s Degree in degree in Finance, Business Healthcare Administration, or another closely related field, required. Master’s Degree preferred.
- Minimum 10 years’ experience in large healthcare systems in contract modelling, analytical service development and execution, and coding analytics in a progressively responsible management role.
- Minimum 10 years’ experience in payor contracting and payor contract administration, including negotiation and proposal evaluation.
- Demonstrated proficiency with varied data analysis software, database software, spreadsheet software, database conversions.
- Detailed knowledge of hospital and physician complex reimbursement methodologies including FFS and value-based care (VBC) risk reimbursement structures including Medicare and Medicaid terms
- Demonstrated experience in being responsible for large groups of employees in a complex, outsourced RCM operational setting.
- Proven expertise in working across geographical locations, within KPI, SLA driven environment.
- Strong executive presence, including communication skills that enable appreciation of others’ perspectives and the ability to offer compelling insights and recommendations.
- Strong analytical capacity.
- Excellent oral and written communication skills and be able to communicate effectively with all levels of management.
- Familiarity with the provider market and competitive landscape and demonstrated experience building and maintaining relationships with payer partners strongly preferred.
- Excellent understanding of contract language and rate terms, physician and hospital coding and billing, claims forms and claim payment methodologies, payer EOBs, and insurance laws.
- Experience with governmental programs related to Medicare, Medicaid managed care and Medicare Advantage highly desirable.