Chicago, IL, 60684, USA
23 hours ago
Payor Contracts/Credentialing Analyst
**Extraordinary Careers. Endless Possibilities.** **With the nation’s largest home infusion provider, there is no limit to the growth of your career.** Option Care Health, Inc. is the largest independent home and alternate site infusion services provider in the United States. With over 8,000 team members including 5,000 clinicians, we work compassionately to elevate standards of care for patients with acute and chronic conditions in all 50 states. Through our clinical leadership, expertise and national scale, Option Care Health is re-imagining the infusion care experience for patients, customers and employees. As a two-year recipient of the Gallup Exceptional Workplace Award, we recognize that part of being extraordinary is building a **thriving workforce that is as unique as the patients and communities we serve.** Join a company that is taking action to develop a culture that is inclusive, respectful, engaging and rewarding for all team members. Our organization requires extraordinary people to provide extraordinary care, so we are investing in a culture that attracts, hires and retains the best and brightest talent in healthcare. **Job Description Summary:** Manage implementation of assigned payer agreements for managed care, pharmacy benefit administrators, IPA, and other third-party payers for Option Care Health. Handle day to day issues that may arise out of existing contractual relationships with payers. Assist with reimbursement issues arising from contracts for medical and pharmacy billing. Assist managing department e-mail for all internal payer issues escalated by revenue cycle management, intake, operations, and sales. Complete assigned credentialing requests, provider information forms, and attestations for pharmacy locations and licensed individual practitioners. **Job Description:** ​ **Job Responsibilities** (listed in order of importance and/or time spent) + Implements third -party payer agreements for managed care, pharmacy benefit administrators, and other accounts for Option Care Health. Creates and distributes contract implementation materials with appropriate internal customers to ensure claims billing systems are set up correctly, and communication of plan specifics are sent to field for instruction and reference. Presents contractual updates on internal implementation calls. + Resolves issues related to contractual arrangements including, but not limited to: contract participation, fee schedules, basic contract terms, benefit type (medical, pharmacy, specialty pharmacy), medical claim denials, and pharmacy claim rejections. + Assists managing the department e-mail for all internal payer issues escalated by revenue cycle management, intake, operations, and sales. + Completes assigned credentialing requests, provider information forms, enrollment forms, and attestations for pharmacy locations and licensed individual practitioners. + Manages communication with assigned accounts as it relates to demographic changes to Option Care Health facilities. + Reviews published information for key payers for updates to the impacted locations. Identifies, assesses, and communicates impact of potential changes or changes related to new state or federal legislation to impacted care management centers. + Maintains successful working relationships with internal departments such as Operations, Legal, Sales, and any other departments that are involved with or impacted by third-party payer contracts. + Attends client meetings where appropriate and in collaboration with Market Access or Contracting team members. + Participate in regional meetings as directed by management. + Assists with ad hoc projects, requests, and initiatives as assigned by management. **Supervisory Responsibilities** Does this position have supervisory responsibilities? (i.e. hiring, recommending/approving promotions and pay increases, scheduling, performance reviews, discipline, etc.) No - X Yes **Basic Education and/or Experience Requirements** + Bachelor’s degree and at least 2 years of experience in managed care account management, contract analysis or administration, payer credentialing, or with managed care payers through patient registration or revenue cycle management, **OR** + High school diploma/GED and at least 5 years of experience in managed care account management, contract analysis or administration, payer credentialing, or with managed care payers through patient registration or revenue cycle management. **Basic Qualifications** + Knowledge of local, state, federal, and other regulations; knowledge of regulations and legal requirements governing the industry. + Demonstrated knowledge and proficiency in the principles, procedures and best practices related to this position. + Experience with analyzing and reporting data in order to identify issues, trends, or exceptions to drive improvement of results and find solutions. + Experience providing customer service to internal and external customers, including meeting quality standards for services. + Experience using time management skills such as prioritizing/organizing and tracking details and meeting deadlines of multiple projects with varying completion dates. + Proficient level of software proficiency in using PC software to support activities, especially Microsoft Office, Word and Excel. **Physical Demand Requirements** + Ability to work on a personal or laptop computer for extended periods of time. **Travel Requirements: (if required)** + Willing to travel up to 10% of the time for business purposes (within state and out of state). **Preferred Qualifications & Interests (PQIs)** + Bachelor's degree preferred. + At least two (2) years of experience of payer credentialing. + At least two (2) years of experience through patient registration or revenue cycle management. Due to state pay transparency laws, the full range for the position is below: Salary to be determined by the applicant's education, experience, knowledge, skills, and abilities, as well as internal equity and alignment with market data. Pay Range is $62,386.44-$103,999.91 **Benefits:** -401k -Dental Insurance -Disability Insurance -Health Insurance -Life Insurance -Paid Time off -Vision Insurance _Option Care Health subscribes to a policy of equal employment opportunity, making employment available without regard to race, color, religion, national origin, citizenship status according to the Immigration Reform and Control Act of 1986, sex, sexual orientation, gender identity, age, disability, veteran status, or genetic information._ ​ For over 40 years, Option Care Health has provided adult and pediatric patients with an alternative to hospital infusion therapy. With more than 2,900 clinical experts, Option Care Health is able to provide high-quality infusion services for nearly all patients with acute and chronic conditions across the United States, resulting in high quality outcomes at a significantly reduced cost. Option Care Health has more than 70 infusion pharmacies and 100 alternate treatment sites. We are guided by our purpose to provide extraordinary care that changes lives through a comprehensive approach to care along every step of the infusion therapy process including: intake coordination, insurance authorization, resources for financial assistance, education and customized treatments.
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