Health Care Payer Network & Credentialing Consultant and Healthcare Claims Auditor & Payer Negotiations Specialist jobs in United States
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Healthcare Building Solutions · 1 month ago

Health Care Payer Network & Credentialing Consultant and Healthcare Claims Auditor & Payer Negotiations Specialist

positionUnited States
timeContract
remoteRemote
seniorityMid, Senior Level

Healthcare Building Solutions is seeking an Independent Consultant to help healthcare organizations expand their reach and secure the right payer contracts. The consultant will guide providers through the payer network application process and analyze service lines to recommend strategic payer networks.

ConstructionHealth CareProject Management
Hiring Manager
Corinne Graber, SHRM-CP
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Responsibilities

Guiding providers through the payer network application process – commercial, Medicare, Medicaid, commercial managed care, Medicare/Medicaid managed care, other
Navigating and meeting credentialing requirements
Analyzing service lines and market data to recommend the most strategic payer networks for specific healthcare services and regions

Qualification

Healthcare payer enrollmentCredentialing requirementsClaims auditingPayer regulationsAnalytical skillsNegotiation skillsCommunication skills

Required

Proven experience in healthcare payer enrollment & credentialing
Strong knowledge of payer requirements and state/regional variations
Analytical skills to assess market opportunities
Excellent communication and client relationship skills
RN or Advanced Practiced Nurse with substantial experience in healthcare claims auditing and compliance
Expertise in payer regulations, CMS billing guidelines, and managed care contracts
Strong negotiation skills with a proven track record of successful appeals
Ability to interpret complex medical records, coding data, and payer policies

Benefits

Flexible, independent contractor role
Opportunities to collaborate with a network of health care consulting professionals making a real difference in care delivery

Company

Healthcare Building Solutions

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Healthcare Building Solutions (HBS) offers solutions for your complete project success.
dateFounded in 2007
location
Langhorne, Pennsylvania, USA
people-size51-200 employees
web-link
https://www.hbsinc.com/

Funding

Current Stage
Growth Stage
Total Funding
unknown
Key Investors
Latticework Capital Management
2021-09-14Private Equity

Leadership Team

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Jay Hornung
President
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Company data provided by crunchbase