Job Description
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Role Description
- This is a remote position. Atlantic Health Strategies is seeking a Part-time Payer Contracting & Credentialing Specialist. In this part-time, remote role, the Payer Contracting & Credentialing Specialist serves as a specialized operational partner to the leadership team. This position supports commercial and Medicaid contracting, credentialing, reimbursement analysis, and billing compliance reviews. The Specialist plays a critical role in ensuring revenue integrity, maintaining accurate payer enrollments, and identifying financial risks before they impact the organization. This is a highly analytical role requiring independent judgment. Work is primarily asynchronous and email-based, with occasional client-facing Teams meetings.
- Payer Contracting:
- Prepare and submit commercial and Medicaid organizational applications, manage MCO enrollment and revalidation processes, and maintain contracting trackers and renewal timelines.
- Reimbursement Analysis:
- Review reimbursement schedules, identify rate variances, and flag contract language that presents operational or financial risk.
- Credentialing Management:
- Manage Type 2 NPI enrollments and service location additions, ensuring taxonomy alignment with licensed levels of care, and coordinate CAQH updates.
- Revenue Integrity:
- Conduct focused billing compliance reviews of behavioral health CPT/HCPCS codes and compare billed services against payer policy and fee schedule guidance.
- Risk Mitigation:
- Identify authorization and documentation risk areas, analyze denial patterns, and recommend corrective actions to leadership.
- Medicaid Research:
- Research state Medicaid fee schedules and managed care reimbursement structures, interpret provider manuals, and provide written analysis to support expansion into new states.
- Performance Reporting:
Summarize reimbursement impact for executive review and maintain accurate, current contracting logs.
- Qualifications
- Minimum 3 years of behavioral health payer contracting experience, specifically with Medicaid MCO enrollment and commercial payer contracting.
- Working knowledge of behavioral health CPT/HCPCS codes, level-of-care billing, and ASAM levels of care.
- Experience analyzing Medicaid fee schedules and payer policy documents to identify variances and risks.
- Strong written communication skills and the ability to provide clear, written reimbursement analysis within defined timelines.
- Ability to operate within a defined scope without drifting into claims submission or RCM execution.
- Requirements
- Ability to work remote, approximately 10 hours per week.
- Minimum 3 years of behavioral health payer contracting experience.
- Direct experience with Medicaid MCO enrollment and commercial payer contracting.
- Working knowledge of behavioral health CPT/HCPCS codes and level-of-care billing.
- Strong organizational, documentation, and interpersonal skills.
- Ability to work independently and collaborate effectively via email and occasional Teams meetings.
- Ability to maintain compliance with HIPAA and relevant behavioral health regulations.
- Benefits
- Competitive Pay ($50/hour)
- Remote / Work-from-home
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