SUMMARY
The Specialist is responsible for identifying and securing public and private insurance contracts; reviews and organizes existing contracts. Assists with the development of potential relationships with strategic partners and creates measurable business results for various markets.
ESSENTIAL JOB FUNCTIONS
To perform this job successfully, an individual must be able to satisfactorily perform each essential function listed below:
Contracting and Credentialing
Works in partnership with Operations Leaders and Director of Contracts and Payor Engagement to ensure consistency and secure public and private insurance contracts
Analyzes and monitors financial aspects of existing contracts and maintains original documentation of all contracts
Identifies, contacts, and creates relationships with potential payors that result in new contracts and increased funding possibilities for program participants
Conducts rate and contract negotiations
Describes services provided to potential contract sources
Communicates with state directors, and state operating/marketing staff regarding contract specifics. Ensures commitments to participants, family, referral sources and payors are met
Communicates contract executions and requirements to all internal departments
Completes contract related credentialing and enrollment application requirements
Maintains database of licenses, accreditation forms, financial and organizational information for the purpose of efficient and timely enrollment application
Oversees Single Case Agreement process within the Admissions Teams. May take lead in difficult single case negotiation
Facilitates resolution of contract related issues with billing and collections team
Performs other related duties and activities as required
SUPERVISORY RESPONSIBILITIES
None
Minimum Knowledge and Skills required by the Job
The requirements listed below are representative of the knowledge, skill, and/or abilities required to perform the job:
Education and Experience:
Bachelor’s degree in Rehabilitation Administration, Business Administration or related field preferred, and/or
Three to five years’ experience with contracts, managed care, and health insurance related industry preferred
Certificates, Licenses, and Registrations:
None required
Other Skills and Abilities:
None noted
Other Requirements:
Occasional travel if needed
Physical Requirements:
• Sedentary work. Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.
AMERICANS WITH DISABILITIES ACT STATEMENT
External and internal applicants, as well as position incumbents who become disabled, must be able to perform the essential job functions either unaided or with assistance of a reasonable accommodation to be determined on a case by case basis via the interactive process.