The specialist manages a portfolio of managed care and government payor contracts, serving as the primary liaison for credentialing, enrollment, and reimbursement matters. They are responsible for negotiating contracts, performing reimbursement audits, and ensuring compliance across the revenue cycle.
Senior Credentialing & Payor Contract Specialist
Location: Remote
Why Ascend?
Come work for a company that is transforming the industry!
Ascend Clinical, LLC is one of the highest-volume clinical laboratories in the United States, processing millions of tests each month with advanced tools and technology. For over 30 years, we've set the standard for service and excellence in testing.
What sets Ascend apart is our unique combination of clinical and healthcare water testing as we drive innovation across multiple areas of laboratory science. We're growing rapidly and looking for individuals who thrive in a fast-paced environment, embrace new challenges, and want to help shape what's next.
Job Summary:
The Senior Credentialing & Payor Contract Specialist is responsible for the strategic management and administration of a portfolio of managed care and government payor contracts for a large national laboratory organization. This role serves as the primary liaison between the laboratories and both contracted and non-contracted payors, fostering strong relationships and ensuring effective communication regarding credentialing, enrollment, reimbursement, and contract matters.
Key responsibilities include submitting applications for new payor agreements, completing initial credentialing applications and revalidations, managing laboratory enrollments, and maintaining compliance with commercial and government payor requirements. The Senior Credentialing & Payor Contract Specialist also supports the loading, maintenance, and validation of fee schedules within the Accounts Receivable system to ensure accurate reimbursement calculations and monthly net revenue reporting.
Responsibilities:
Key liaison between laboratories and contracted and non-contract payors. Establish and maintain strong business relationships with key payor contacts to ensure continuous market access nationally
Responsible for managing, maintaining, and negotiating all insurance contracts to include commercial, managed care, and government payors
Provide credentialing and re-credentialling of all payors and non-participating registrations and enrollments
Serves as subject matter expert in payer enrollment & credentialing to advise business units on complex requirements and financial risks related to open new labs, relocations, mergers & acquisitions, and closures
Performs audits of reimbursement and contract performance, identifies and resolves unfavorable payor variances, and implements corrective actions as needed. Through proactive monitoring, analysis, and cross-functional collaboration, this position plays a critical role in maximizing reimbursement, mitigating revenue leakage, and ensuring operational excellence across the revenue cycle
Research and maintain reimbursement schedules for all contracted and non-contracted payors to include commercial, government, and managed care insurance carriers
Work with electronic clearinghouse to ensure all enrollments are complete, maintain accurate payor identifiers, and resolve compliance denials and rejections with electronic data interchange (EDI) through electronic claims (837), electronic remittances (835), eligibility transactions (270/271), and electronic funds transfers (EFTs)
Servers as the administrator for all commercial and government payor websites. Initiates access and terminations for all staff
Maintain insurance master, contract groups, and monitor payor performance using the data warehouse
Qualifications:
Minimum Associate Degree in Business or related field. Bachelors’ degree in Business, Accounting, or Healthcare is preferred. Must have at least 6 years of experience managing commercial and/or government payor contracts in a healthcare environment. Experience in credentialing/contracting for a laboratory that supports Chronic Kidney Disease & End Stage Renal Disease is required
Thorough understanding of commercial, managed care, and government Payors to include reimbursement methodologies, and contract language. Understanding of electronic data interchange (EDI) standards. Must be detailed oriented, organized, and results driven
To perform this job successfully, an individual must have proficient skills in Microsoft Office (Excel and Word), experience using Adobe or other PDF editors. Basic knowledge of SQL Server database’s is a plus
Compensation:
- $36.46/hr
Benefits:
As an Ascend Clinical employee, you will become part of a company that has received national recognition as a great place to work. We offer excellent full-time benefits including comprehensive medical coverage, life and disability insurance, 401(k) with company match, paid holidays and vacation, personal days, and dental and vision options.
Ascend is an Equal Opportunity Employer - M/F/Disabled/Veteran
Ascend Clinical, LLC is committed to promoting an equal employment opportunity workplace environment and is an equal opportunity employer. It is the policy of the company that all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, citizenship, pregnancy, genetic information (GINA), disability, military and/or veteran status, and/or any other status protected by applicable Federal, state, or local law. The company’s policy is to recruit, hire, train, promote and administer all employment-related matters on the basis of an individual's qualifications, abilities and efforts without regard to protected status.
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