Since 2010, PDI Health has provided portable x-rays and ultrasounds to long term care facilities and homebound populations. PDI currently services 15 states and is rapidly expanding.

General Summary:

We are looking to hire a brilliant Managed Care/Credentialing Director to join our dynamic team

As we are expanding, our Managed Care/Credentialing Director will play a key role in enrolling with a variety of health insurance payers.

Primary Responsibilities include:

It is the Managed Care/Credentialing Director's job to get PDI on payer networks and negotiate favorable contracts in new states where PDI is expanding.

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  Monitor Insurance Contracts and process re-enrollment, including Medicare, Medicaid, Medicaid Managed Care, Medicare Advantage plans, and Commercial plans. Negotiate updated rate increases with MCOs as needed. Track contracts progress of rate increases, addendums, and dates of execution on the contract tracker spreadsheet.
• Review and analyze current payors rates
• Review and analyze current payors denials and issues
• Renegotiate rates with current payors
• Execute new contracts, addendums as well as single case agreements as necessary.
• Coordinate with Provider Representatives of Managed Care and 3rd Party Insurance Companies to schedule quarterly meetings with Reimbursement Department.
• Keep the billing team, Eligibility Specialist, and Reimbursement Department informed of all Managed Care, Medicaid, and 3rd Party Insurance of any billing and authorization changes.
• Monitor denial trends and report immediately to upper management
• Must have extensive knowledge of 3rd Party Insurance, Medicare, Medicaid, and Medicaid Managed Care billing requirements

EXPERIENCE:

• Healthcare Insurance verification, billing practices, pre-authorization requirements for Medicaid, Medicaid MCO, Medicare, Medicare Advantage Plans, and 3rd Party Insurance.
• Knowledge of credentialing and contracting requirements for Managed Care, Medicaid, Medicare, and 3rd Party Insurance.
• Existing relationship with payors
• Experience utilizing LinkedIn to identify proper contacts in payor organizations
• Prefer experience in radiology
• Experience with provider credentialing databases/websites/portals (i.e.- CAQH, NPPES and PECOS)

ABILITIES:

• Proficient in all phases of insurance contracting and credentialing.
• Excellent organizational skills.
• Excellent time management, multi-tasking, critical thinking, and accuracy skills.
• Good communication skills when talking with Insurance companies and their representatives concerning payments, denials, and appeals.
• Will be knowledgeable of all aspects of State, Medicaid, Medicaid MCO, 3rd Party Insurance, and Medicare contracts and ensure adherence to those requirements
• Insurance Verification and Pre-Authorizations - Will be responsible to help the billing team and Eligibility for verification and pre-authorization of services if needed.

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

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