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Role Description
This is a remote position. Atlantic Health Strategies is seeking a Part-time Payer Contracting & Credentialing Specialist. In this part-time, remote role, the Payer Contracting & Credentialing Specialist serves as a specialized operational partner to the leadership team. This position supports commercial and Medicaid contracting, credentialing, reimbursement analysis, and billing compliance reviews. The Specialist plays a critical role in ensuring revenue integrity, maintaining accurate payer enrollments, and identifying financial risks before they impact the organization. This is a highly analytical role requiring independent judgment. Work is primarily asynchronous and email-based, with occasional client-facing Teams meetings.
• Payer Contracting:
Prepare and submit commercial and Medicaid organizational applications, manage MCO enrollment and revalidation processes, and maintain contracting trackers and renewal timelines.
• Reimbursement Analysis:
Review reimbursement schedules, identify rate variances, and flag contract language that presents operational or financial risk.
• Credentialing Management:
Manage Type 2 NPI enrollments and service location additions, ensuring taxonomy alignment with licensed levels of care, and coordinate CAQH updates.
• Revenue Integrity:
Conduct focused billing compliance reviews of behavioral health CPT/HCPCS codes and compare billed services against payer policy and fee schedule guidance.
• Risk Mitigation:
Identify authorization and documentation risk areas, analyze denial patterns, and recommend corrective actions to leadership.
• Medicaid Research:
Research state Medicaid fee schedules and managed care reimbursement structures, interpret provider manuals, and provide written analysis to support expansion into new states.
• Performance Reporting:
Summarize reimbursement impact for executive review and maintain accurate, current contracting logs.
Qualifications
• Minimum 3 years of behavioral health payer contracting experience, specifically with Medicaid MCO enrollment and commercial payer contracting.
• Working knowledge of behavioral health CPT/HCPCS codes, level-of-care billing, and ASAM levels of care.
• Experience analyzing Medicaid fee schedules and payer policy documents to identify variances and risks.
• Strong written communication skills and the ability to provide clear, written reimbursement analysis within defined timelines.
• Ability to operate within a defined scope without drifting into claims submission or RCM execution.
Requirements
• Ability to work remote, approximately 10 hours per week.
• Minimum 3 years of behavioral health payer contracting experience.
• Direct experience with Medicaid MCO enrollment and commercial payer contracting.
• Working knowledge of behavioral health CPT/HCPCS codes and level-of-care billing.
• Strong organizational, documentation, and interpersonal skills.
• Ability to work independently and collaborate effectively via email and occasional Teams meetings.
• Ability to maintain compliance with HIPAA and relevant behavioral health regulations.
Benefits
• Competitive Pay ($50/hour)
• Remote / Work-from-home