Contracts And Credentialing Manager (management Analyst Iii)

Fairfax, Virginia
$69,407.31 - $115,678.37 Annually
Jul 24, 2021
Aug 07, 2021
Full Time
Job Announcement

Exciting opportunity in contracts and credentialing management to join the Fairfax-Falls Church Community Services Board (CSB) as a Contracts and Credentialing Manager now available! The position will be located primarily at the Pennino building, with the expectation that travel to other CSB locations may be needed, when meetings or site visits require it. Under the direction of the CSB Director of Behavioral Health Operations, the Contracts and Credentialing Manager will oversee the implementation, renewal, and maintenance of all CSB insurance and MCO contracts required for billing of services. Will supervise and direct the staff and facility credentialing process and manage the agency’s identifier numbers (NPI, Tax ID, etc). Liaison between the CSB legal representation and drive the review of all amendments and contract language. Oversee the maintenance of accurate credentialing information in our electronic health record.

Responsible for identifying new insurance and MCO contracts needed to maximize on billing for services the CSB provides. Initiates the contracting process and provides feedback to legal for review of terms and conditions. Will maintain and renew already established contracts with insurances and MCOs, as required by each organization. Identify and maintain value-based contracts with organizations who will utilize this method for determination of reimbursements.

Oversees the credentialing manager’s work and supports with work on maintenance of staff and facility credentialing profiles with each insurance or MCO and within the electronic health record. Provides guidance on the agency’s credentialing process for staff required to be paneled with the insurances and MCOs. Supports the credentialing manager’s maintenance of the agency staff roster, agency identifier numbers, and credentialing requirements.

Serves as the primary liaison between insurances and MCOs to the CSB, addressing implementation and change in procedures. Informs other CSB programs of feedback provided by the insurances and MCOs (such as implementation of new CPT codes, challenges with claim payments, etc).

Manages and supports all CSB related insurance and MCO challenges, representing the CSB from a contractual perspective on disputes or identified issues.

Functional areas: Contracts, Credentialing, Insurance Verification, Electronic Health Records, or Behavioral Health Administration

Note: To learn more about careers that make a difference, watch our video " CSB: Making a Difference in Our Community ".

Illustrative Duties

(The illustrative duties listed in this specification are representative of the class but are not an all-inclusive list. A complete list of position duties and unique physical requirements can be found in the position description.)
  • Independently designs, develops, and coordinates ongoing department programs and special projects;
  • Performs a wide range of professional-level management work for more than one broad administrative function including complex analysis and diverse project management in a lead capacity;
  • Coordinates and manages the work of administrative, para-professional, and/or professional-level staff in the day-to-day activities of selected projects. Plans, organizes, and coordinates changes to the policies, procedures, or processes related to multiple administrative functions (financial, procurement, budget, human resources, contract or grants administration, information technology systems, etc.);
  • Plans and conducts or oversees studies or research activities to ensure program quality, determine unmet needs or ensure efficacy of existing programs;
  • Provides guidance, recommendations, and advice to departmental managers;
  • Serves on committees, task forces, and management teams to evaluate the effectiveness and efficiency of existing management/administrative systems;
  • Writes, edits, and finalizes reports and presentations and presents findings and recommendations to department senior managers.

Required Knowledge Skills and Abilities

(The knowledge, skills and abilities listed in this specification are representative of the class but are not an-all inclusive list).
  • Considerable knowledge of mission, goals, and objectives of the organizational unit, program, or activities to which incumbent is assigned;
  • Considerable knowledge of the principles, practices, and techniques relating to the functional area of business operation (e.g. personnel, budgeting and financial management, contract administration and management);
  • Knowledge of the principles, practices and techniques governing management, organization, operations and programmatic services;
  • Ability to identify possible solutions for solving business problems;
  • Ability to evaluate proposals and solutions in terms of benefits, costs, and overall impact on the project, program, or organization;
  • Ability to make oral presentations to department management, other departments, or the public;
  • Ability to write detailed, accurate reports, grants, or solicitations for pertinent areas of administration;
  • Ability to use word processing and presentation software to prepare documents, and to use spreadsheet and statistical analysis software packages to store, manipulate, analyze and present data;
  • Ability to supervise and train staff;
  • Ability to lead assigned employees, including delegating and reviewing work assignments, providing coaching and guidance, monitoring and evaluating performance, and supporting training and development planning.

Employment Standards

Any combination of education, experience, and training equivalent to the following: (Click on the aforementioned link to learn how Fairfax County interprets equivalencies for "Any combination, experience, and training equivalent to")
Graduation from an accredited four-year college or university with a bachelor's degree in field related to the assigned functional area; Plus four years of professional work experience with in the functional area.

Valid Driver's License.

The appointee to this position will be required to complete a criminal background check, a Child Protective Services Registry check, a driving record check, and sanction screening to the satisfaction of the employer. A TB screening upon hire.

  • Experience with developing and negotiating contracts with Virginia MCOs, Federal, and Commercial payors.
  • Knowledge of the credentialing process (CAQH, NPPES, MCO Portals).
  • Highly organized, able to manage multiple databases and contracts.
  • Strong oral and written communications skills.
  • Strong supervisory skills and personnel management experience.

Ability to stand, stoop, bend, stretch, walk, climb, sit, type on a keyboard, and lift up to 15 pounds. Acuity of vision is required to read data on a computer monitor. Ability to use keyboard-driven equipment and communicate clearly with others. All duties performed with or without reasonable accommodations.

Panel Interview and may include a practical exercise.

Fairfax County Government prohibits discrimination on the basis of race, color, religion, national origin, sex, pregnancy, childbirth or related medical conditions, age, marital status, disability, sexual orientation, gender identity, genetics, political affiliation, or status as a veteran in the recruitment, selection, and hiring of its workforce.

Reasonable accommodations are available to persons with disabilities during application and/or interview processes per the Americans with Disabilities Act. Contact 703-324-4900 for assistance. TTY 703-222-7314. EEO/AA/TTY.

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