Payer Strategy & Credentialing Manager

Join Max Surgical Specialty Management, an innovative leader in the healthcare industry, as we embark on an exhilarating journey of growth and expansion. We're on the lookout for a Payer Strategy & Credentialing Manager to join our team at our Hackensack, New Jersey office with the opportunity to work hybrid, offering the perfect balance of remote flexibility and in-office collaboration!The Payer Strategy & Credentialing Manager reports directly to the Chief Operating Officer and works cooperatively with MAX's executive team, departmental leaders, and partner surgeons. She is primarily responsible for maximizing UCR fees, negotiating and optimizing third party payor rates, and assuring surgeon credentialing to maximize reimbursement for surgical services. She will be expected to effectively partner with internal and external stakeholders and vendors, set clear and defined project goals, lead, or contribute to payor strategy and credentialing special projects, and empower staff in a collaborative manner that achieves overarching business goals. She will be accountable for delivering timely results while keeping projects within the scope of budgeted expense.What You'll Do:Ensures effective completion of annual UCR fee analysis for all MAX practicesUpdate all UCR fee changes in platform EMR-PMS systems, and effectively communicate changes through Revenue Cycle and Operations teamsApplies key analysis and negotiation results of UCR fee changes to MAX annual operational budget process, while updating and tracking business impact accordinglyLeads third party analysis of all managed practice(s) & future partner practices under LOI inclusive of UCR fee analysis, demographics, and payer related opportunitiesExecute SOW review and engages third parties in special payer related projectsOrganizes, tracks, and leads third party support team in all projects tied to fees, rates, negotiations, and credentialing on an ongoing basisEnsures effective practice level surgeon credentialing and re-credentialing, performs annual reviews of credentialing status, recommending dropadds when appropriateManages multiple databases, insurance portals, and surgeon specific credentialing data bases Effectively scales and administrates the Credential-My-Doc system across all MAX surgeons & practices to create efficiency in credentialing processPerforms riskbenefit analysis of surgeon participation in networks, using data to make recommendations or drive decisions when appropriate Works interdepartmentally to ensure all surgeon "new hires" are effectively credentialed and strategically positioned to maximize reimbursement for servicesWhat You'll Bring:Bachelor's degree in business or a related field preferred but not requiredOral surgery and payer strategy & credentialing experience expectedMeticulous, initiative-taker, able to multi-task and communicate across functionsExhibits sound judgment, prioritization, and decision-making skillsEnergetic, eager to tackle new projects, and comfortable with high-level ExecutivesA collaborator with a resourceful, can-do attitude that thrives in a demanding environmentStrong organization, time-management, verbal, non-verbal, and written communication skillsMust have a valid driver's license, reliable transportationInitiative-taking and purposeful with the ability to work independently and as part of a teamTechnical proficiency in Microsoft Office & ExcelAbout MAX-SSM:At MAX-SSM we are dedicated to optimizing patient outcomes through personalized care, cutting-edge technology, and unwavering professional integrity. By partnering with esteemed practices such as Riverside Oral Surgery, Oral Surgery Group, Coastal Oral Surgery, Vermont Oral Surgery Associates, Northern Vermont Oral Surgery, New England Oral Surgery, New York Oral Maxillofacial & Implant Surgery, Lititz Oral Surgery, Fairfield Oral Surgery, and Begley Oral and Maxillofacial Surgery, we ensure that every patient receives exceptional care, every tegrity-driven. Patient-focused. Experience the difference at Surgical Specialty Management is an equal opportunity employer committed to providing fair employment opportunities regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, genetic information, marital status, veteran status, or any other legally protected characteristic. We welcome diversity and encourage applicants from all backgrounds. Our inclusive environment values and empowers every employee to contribute to our mission.Powered by JazzHRj8LnGiHpow

Created: 2025-03-01