Manager, Credentialing & Facility Contracts - Hybrid / Bannockburn Il

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 6,000 team members including 2,900 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 proud recipient of the Gallup Exceptional Workplace Award, we recognize that part of being extraordinary is supporting and building a workforce that is as diverse as the patients and communities we serve.
Join a company that is taking action to develop a culture that is more inclusive, respectful, engaging and rewarding for all team members. We are committed to hiring, developing, and retaining a diverse workforce.
Job Description Summary:
Oversees the management of all network, payer credentialing and re-credentialing under the direction of the Senior Director, Contracting. Manages administrative tasks and assignments related to the credentialing and facility contract processes for Option Care Health entities and Option Care Infusion Suites individual practitioners. Manages the contracting process for facility agreements.
Job Description:
Job Responsibilities (listed in order of importance and/or time spent)

• Manages the preparation and submission of initial credentialing and re-credentialing for commercial payer network systems. Assists corporate and field personnel if they have questions about pending credentialing applications.
• Manage the negotiation of Facility Contracts in accordance with company guidelines for home and alternate site infusion therapy services provided by Option Care Health. Work with sales team members to review and route for execution agreements with hospitals, home health agencies hospices, and skilled nursing facilities.
• Responsible for the management and performance of high-volume e-mail box that serves as the single point of contact for all credentialing and internal payer issues.
• Oversees the completion of contract compliance attestations, payer training attestations, and third-party payer disclosures. Initiates and engages in communication with third party payers to resolve any potential non-compliance. Collaborates with Chief Compliance Officer to maintain consistency with internal policies and procedures. Informs internal parties of any potential non-compliance issues.
• Manages the credentialing and re-credentialing process for individual practitioners for CAQH, Medicaid, and commercial payers.
• Maintains current knowledge of federal, state, and local laws regarding contracts, third party contracted programs, and credentialing requirements.
• Oversees the development, implementation and maintenance of credentialing policies and procedures.
• Serves as a liaison between the corporate, branch and field personnel for all network, and payer credentialing matters. Collaborates with internal parties to ensure clear, and consistent communication of issues related to each client/Payer as needed.
• Works closely with the Contracting and Market Access Departments to ensure locations are properly credentialed pursuant to payer and provider Agreements.
• Manages the development and maintenance of credentialing tracking to ensure timely follow-up with various departments regarding credentialing status, and maintains knowledge of status and information within contracts. Communications with Area Vice Presidents, Contracting team, Operations, and other internal parties as appropriate.
• Works to resolve credentialing licensing, matters as required.
• Provides guidance with credentialing, and enrollment for any new locations. Furthermore, ensures proper credentialing, and enrollments are in place for any site consolidations.
• Communicates with managed care payers and pharmacy benefit managers of demographic changes.
• Assists with ad hoc projects, requests, and initiatives as assigned by managements.
• Reviews requests for proposal responses for credentialing, compliance, and attestation support.

Supervisory Responsibilities
Does this position have supervisory responsibilities? Yes
(i.e. hiring, recommending/approving promotions and pay increases, scheduling, performance reviews, discipline, etc.)
Basic Education and/or Experience Requirements

• Bachelor's Degree and at least five (5) years of experience working with payers in the healthcare industry, OR High school diploma/GED and at least eight (8) years of experience working with payers in the healthcare industry.
• At least three (3) years of experience of payer and facility credentialing, or healthcare administration.

Basic Qualifications

• Knowledge of local, state, federal, and other regulations; knowledge of regulations and legal requirements governing the industry.
• 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.
• Demonstrated knowledge and proficiency in the principles, procedures and best practices related to this position.

Physical Demands/Work Environment

• While performing the duties of this job, the employee may be regularly required to stand, sit, talk, hear, reach, stoop, kneel, and use hands and fingers to operate a computer, telephone, and keyboard.
• Specific vision abilities required by this job include close vision requirements due to computer work.
• Light to moderate lifting may be required.
• Moderate noise (i.e., business office with computers, phone, and printers, light traffic).
• Ability to sit at a computer terminal for an extended period.

Travel Requirements: (if required)
0%
Preferred Qualifications & Interests (PQIs)

• At least two (2) years of experience of healthcare contract coordination or administration.
• Bachelor's Degree preferred.
• At least two (2) years payer and facility credentialing experience.

Due to some state pay transparency laws, below is the minimum pay for the position:
Salary to be determined by the applicant's education, experience, knowledge, skills, and abilities, as well as internal equity and alignment with market data.
Minimum pay is $77,424.82+
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.