Payer Contracting Expert/Network Developer
Posted on Saturday, December 23, 2023
Plume is a mission-driven, trans-founded company focused on radically increasing access to healthcare for the transgender and gender-nonconforming communities. Our vision is to transform healthcare for every trans life and build a virtual care home for the trans community. As a rapidly expanding organization, we are now proudly available to more than 1 million transgender individuals in 45 states. We are an organization formed through the lived experience of trans people and fierce allies, and we welcome other heart-forward, talented individuals to join our team on this journey.
If you share our mission and values, possess experience as a Payer Contracting Expert with a background in Credentialing and Contracting, and have a deep understanding and affinity for the trans experience, we encourage you to continue reading!
About the Role:
The Payer Contracting Expert role is a vital position within our Credentialing and Contracting team, entrusted with overseeing all aspects of payer contracting lifecycle. Your deep passion for supporting the underserved trans community and eagerness to play a crucial role in broadening access to care are invaluable.
This role is a key part of our fee-for-service reimbursement strategy, offering a unique opportunity for motivated individuals to make an immediate and significant impact. You'll be at the forefront of developing and executing our payer contract management initiatives, playing an integral role in fostering strong payer relationships and managing contracts efficiently, contributing significantly to the operational success of our organization. If this sounds like the right challenge for you, we encourage you to apply and join us in making a difference.
- Proven track record in payer contracting and provider credentialing, with at least two years of experience.
- Manage the research, preparation, and submission of contract applications, including credentialing and enrollment forms as required by plans. Diligently track and report on the progress of each submission.
- Familiarity with various insurance plans and healthcare payment systems.
- Proficiency in managing relationships with insurance payers.
- A proven passion for and affinity with the mission of Plume, to transform healthcare for every trans life
- Understanding of healthcare regulations, including HIPAA, and federal and state laws.
- Familiarity with the specifics of credentialing standards and processes.
- NCQA experience is a definite plus.
- Ability to effectively communicate with various stakeholders, including insurance representatives, healthcare providers, and team members.
- Skilled in both written and verbal communication.
- Aptitude for analyzing contract terms, reimbursement rates, and fee schedules.
- Ability to identify and resolve discrepancies and issues in payer contracts.
- Strong organizational and time-management skills, with an ability to prioritize tasks effectively.
- Demonstrated understanding and empathy towards the trans experience.
- Commitment to inclusivity and respectful communication.
- Familiarity with healthcare IT systems, credentialing databases (Salesforce), and GSuite.
To apply, please go to https://getplume.co/careers/ and apply from there. We do have a few key questions we'd like to ask you, that don't show up when you click, "apply" on this job board. Those who take the trouble to answer the questions will be considered much more heavily than those who just click, "apply." here.
Plume is an equal opportunity employer. Trans and gender-nonconforming individuals are strongly encouraged to apply, particularly those who identify as people of color. We positively encourage applications from suitably qualified and eligible candidates regardless of age, color, disability, national origin, ancestry, race, religion, gender, sexual orientation, gender identity and/or expression, veteran status, genetic information, or any other status protected by applicable law.
Must be eligible to work in the US without a visa. No recruiters, please. Applicants only.