Shire Jobs

Volunteers of America National Services- PACE is seeking a Contracting and Credentialing Manager to support Program of All-Inclusive Care for the Elderly (PACE) centers including CO and KY. Schedule: M-F 8:30 AM-5:30 PM *Remote Benefit Highlights: * 403(b) Retirement Plan * Career scholarships; * Continuing career education and leadership programs; * Dental and Vision Insurance * Paid Time Off (Vacation, Holiday & Sick Days) About the Job Manages outside provider/vendor contracted services to create and maintained a stable, credentialed and quality network of PACE Providers. Assures compliance with PACE regulations and external standards including the National Committee for Quality Assurance. Negotiates rates for contracted services in accordance with industry standards and in the best interest of program financial viability. Serves as primary relationship manager for all contract related issues with contracted providers. Essential Functions * Maintains, with legal counsel oversight and input, contract and business associate agreement templates for all contracted PACE services including primary care, specialty care, acute and tertiary care, skilled nursing facilities, residential facilities, dialysis, DME, participant supplies, ambulance, home care/personal care * Develops, maintains, nurtures and terminates contractual relationships with high quality, cost effective PACE contracted service providers including negotiating rates within Medicare and Medicaid standards, executing contracts, maintaining credentials and generating provider network listings and directories * Monitors and analyzes the provider market continuously to identify leads that will enhance and ensure service access for the participants served by VOANS PACE Organizations while meeting VOA and VOANS diversity expectations * Executes out of network business agreements * Assures all contracted provider credentialing is maintained on a timely basis and documented in accordance with PACE regulations, state contracts and industry standards including, if applicable current licenses, registrations, DEA license, certifications, certificates of liability insurance, state surveys, etc. * Maintains all electronic and manual provider files * Collaborates with provider relations team to conduct initial and on-going provider orientation to assure understanding and compliance with PACE regulations, state contracts, state regulations and industry standards; assures all attestations and receipts are signed and filed * Ensures updated annual trainings and materials are provided to contracted providers * Collaborates with claims administration staff to support timely and proper payment to providers per provider contracts, state contracts and industry standards * Manages and maintains provider directories to ensure information is updated in a timely manner per PACE regulations * Collaborates with Quality staff to assure contracted providers meet regulatory and contractual quality requirements * Develops necessary policies and procedures related to network development, contract management and credentialing * Maintains Provider Database to communicate appropriate contract information, including responsibility for updating provider information * Conducts initial credentialing and re-credentialing of applicable providers * Performs other duties as required and requested Key Competencies * Exceptional presentation and oral and written communication skills including email, phone, Zoom and in-person * Demonstration of good people skills * Advanced skills in Office including Outlook, Word, and Excel * Advanced negotiation skills * Highly analytical * Ability to multitask and balance significant work load * Ability to collaborate with internal team members to achieve organizational goals Required Qualifications * Bachelor's degree in related field required; Master's degree preferred * At least 5 years of experience of professional and institutional medical contracting including knowledge of coding, credentialing, NCQA and PACE Regulations and experience in rate negotiation and management * Advanced skills in Office including Outlook, Word, and Excel * At least one year of working with a frail elderly population * Ability to travel as requested At VOANS, we celebrate sharing, encouraging and embracing diversity. Equal employment opportunities are available to all without regard to race, color, religion, sex, pregnancy, national origin, age, physical and mental disability, marital status, parental status, sexual orientation, gender identity, gender expression, genetic information, military and veteran status, and any other characteristic protected by applicable law. We believe that blending individual strengths and unique personal differences nurtures and supports our organizations' shared commitment to our mission and creates an inclusive and diverse environment where everyone feels valued and has the opportunity to do their personal best