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Job Title: Ancillary Contractor,Mngd Care

Company: NorthEast Provider Solutions Inc.

City/State: Valhalla, NY

Category: Professional/Non-Clinical

Department: Managed Care-WMC Health

Position: Full Time

Hours: mon-fri 8 hrs per day

Shift: Day

Req #: 28199

Job Details:

Job Summary:

The Ancillary Contractor will assist in contracting for new rates and language for physician groups and ancillary facilities. The incumbent may also assist with hospital agreements with various managed care organizations, including completion of single case agreements.

Responsibilities:

· Reviews Agreements, amendments, rate addendums for completeness and appropriate approval and signatures. · Ensures credentialing information is complete based on the requirements of the specific provider type. · Obtains most current insurance certificates on behalf of the network. · Works with internal departments to resolve issues concerning contract language interpretation and rate information. · Researches and resolves routine provider operational issues with managed care payers. · Schedules Joint Operation Committee (JOC) meetings with Managed Care Payers and key departmental heads within the network. · Updates various rate grids with most current rates. · Reviews and provides recommendations on single case agreements. · Assists with settlements with both participating and non-participating managed care payers. · The ancillary contractor role has the ability to make decisions with regards to: o Single Case Agreements: dollar amount to reject/and or provide a counter rate, then presents for execution of the document o Credentialing on behalf of the Hospital and ancillary services: determines if the request is valid, completes applications and provides for signature. o Transfer request to another Facility: determines if the financial impact meets our criteria and advises if the patient is financially clear to be transferred out. · Performs other duties as assigned. Qualifications/Requirements:

Experience:

Five to seven years work experience in related managed care field

Education:

Associates degree or equivalent experience required.

Licenses / Certifications:

NA

Other:

About Us:

NorthEast Provider Solutions Inc.