Job Description

Contract and Insurance Credentialing Analyst

Cancer care is all we do

Hope in healing

Cancer Treatment Centers of America® (CTCA®) takes a unique and integrative approach to cancer care. Our patient-centered care model is founded on a commitment to personalized medicine, tailoring a combination of treatments to the needs of each individual patient. At the same time, we support patients’ quality of life by offering therapies designed to help them manage the side effects of treatment, addressing their physical, spiritual and emotional needs, so they are better able to stay on their treatment regimens and get back to life. At the core of our whole-person approach is what we call the Mother Standard® of care, so named because it requires that we treat our patients, and one another, like we would want our loved ones to be treated. This innovative approach has earned our hospitals a Best Place to Work distinction and numerous accreditations. Each of us has a stake in the successful outcomes of every patient we treat.

Job Description:

The Contract and Insurance Credentialing Analyst (CICA) is accountable for completing and maintaining enrollment applications in a timely manner for newly credentialed providers with our contracted payers for all CTCA entities.  For new CTCA contracts, the CICA is responsible for the professional corporation insurance credentialing, facilitates new hospital contract implementation within Pt Accts, assigning codes and identifiers for tracking purposes, communicates contract changes and oversees patient accounts department record retention. The CICA manages the relationships and communications between Corporate Contracting, Site Medical Staff Offices, third party payers and all Patient Accounts Stakeholders. The CICA is the internal Patient Accounts professional services expert for all payer contracts and is the resource for escalated contracting and credentialing issues, acting as a gatekeeper to prevent unbillable revenues for timeliness of claim filing, application approvals, etc. that prevent CTCA from receiving appropriate compensation for services rendered. Develops communication and training strategies with appropriate CTCA internal teams concerning relevant payer contract terms, reimbursement discrepancies as well as patient insurance benefit clarification. Coordinates, manages and leads CICA Assistant daily duties and project responsibilities (i.e. in-network and out of network credentialing). Coordinates, manages and leads CICA’s daily duties and responsibilities.  The CICA reports directly to the Director Claims Services - Patient Accounts.

Job Accountabilities

30%

  • Collaborates with payers, Corporate Compliance and Corporate Payer Contracting team as the liaison for Pt. Accounts for current reimbursement and contract updates as well as patient benefit clarification.
  • Responsible for working payer contract related projects for internal escalation.
  • Maintains and updates the Payer Contract list on the CTCA Empower Net site.
  • Coordinates implementation of new payer adjustment and payment service codes.
  • Payer policy standards or changes to be distributed to all affected CTCA Stakeholders insuring that the correct contractual and payments are posted and outstanding accounts to be worked effectively.
  • Responsible for reporting on AR data experience from appropriate systems to analyze reimbursement results to review overall contract performance and verify expected reimbursement.
  • Discrepancies detected to be promptly reported to Director Claims Services - Patient Accounts and Payer Contracting if applicable.

25%

  • Oversees the daily operations of the CICA Assistant.
  • Provides direction during external audits and projects requiring data to be manually gathered. 
  • Conducts first level interviews and makes hiring recommendations.
  • Authorizes payroll and manages accruals.
  • Enforces departmental and CTCA policies and procedures.
  • Prepares Quarterly QA assessments and annual reviews.
  • Monitors and reports on Assistant’s productivity, skill strengths or weaknesses with regard to handling calls and processing mail.

40%

  • Manages insurance credentialing for all providers at all facilities.
  • Works closely with Site Finance, site Medical Staff Offices, and Patient Account Leadership to expedite physician insurance credentialing.
  • Creates and reviews accounts holding for provider enrollment with CTCA’s contracted payers.
  • Supplies data regarding pending insurance credentialing to site CFO’s/CEO’s as well as Dir Quality Performance - Patient Accounts monthly.

5%

  • Attends monthly Pt. Accounts, Stakeholder and any meetings as requested.
  • The CICA meets with Dir Quality Performance - Patient Accounts on at a minimum of bi-weekly and submits activity report at the bi-weekly meeting.
  • Is flexible, organized and is able to meet deadlines as necessary.
  • At all times adheres to written CTCA, MRMC and Pt. Accounts specific policies and procedures, CTCA Financial Policy and all HIPAA rules and regulations.

Education/Experience Level ?

  • Bachelor’s degree required.
  • Prior Supervisory Experience is preferred. 
  • Must have 2-3 years A/R experience in a hospital or physician healthcare setting which will include insurance and self-pay healthcare collections/billing as well as insurance verification experience.

Knowledge and Skills

  • Must be capable of leading a team.
  •     Must have excellent organizational skills, and be able to manage multiple priorities and responsibilities.
  •     Must have outstanding communication and customer service skills.
  •     Must have solid knowledge of payer contracting terms and ability to read and interpret contracts.
  •     Must have knowledge of accounting principles and statistical analyses.
  •     Must have solid knowledge of medical terminology, ICD9 codes, CPT/HCPC’s codes.
  •     Must have advanced written and verbal communication skills.
  •     Must have minimum two-years of basic computer use and background.
  •     Must have outstanding communication and customer service skills.
  •     Must have strong analytical skills.
  •     Must be able to perform routine mathematical, color coding and alphabetizing.
  •     Must have experience with account reconciliation and balancing.
  •     Must be capable of leading a team.
  •     Must be capable of speaking in large groups and conducting meetings.
  •     Must have excellent organizational skills, and be able to manage multiple priorities and responsibilities.
  •     Must be efficient, reliable, flexible, goal oriented and adaptable to change; while maintaining high    productivity levels.
  •     Must be team oriented.
  •     Must be courteous and professional.
  • Must be willing to travel, as needed. 

We win together

Each CTCA employee is a Stakeholder, driven to make a true difference and help win the fight against cancer. Each day is a challenge, but this unique experience comes with rewards that you may never have thought possible. To ensure each team member brings his or her best self, we offer exceptional support and immersive training to encourage your personal and professional growth. If you’re ready to be part of something bigger and work with a passionate, dynamic group of care professionals, we invite you to join us. 

Visit:  Jobs.cancercenter.com to begin your journey.

Application Instructions

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!

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