Payer Credentialing and Contract Manager

At STRIDE Community Health Center, we’re dedicated to more than just providing healthcare, we’re committed to making a lasting impact on the lives of our patients and the communities we serve. As one of Colorado’s largest Federally Qualified Health Centers, we offer comprehensive services, including primary care, dental, pharmacy, behavioral health, health education, and outreach, across our 13 clinics in the Denver Metro area.

With over 35 years of serving our community, our growing team is at the heart of this mission. We believe healthcare is about more than treating illness; it's about fostering wellness and addressing the unique needs of every person, ensuring that no one is left behind. If you’re passionate about making a meaningful difference, thrive in a collaborative environment, and are ready for a career that transforms lives, including your own - STRIDE is the place for you.

General Purpose: The Payer Credentialing and Contract Manager coordinates and facilitates all payer and provider enrollment activities related to new and existing providers and health center locations to ensure reimbursement of all services rendered and maintains STRIDE’s systems according to payer contract.

Essential Duties/Position Responsibilities:

• Ensures timely and accurate medical group and individual enrollments with government, commercial, and pharmacy payers for FQHC and professional fee claim reimbursement.
• Follows up with managed care organizations and government payers to ensure timely and accurate enrollment.
• Builds and updates the Epic Professional Billing system to support billing activities, including fee schedule management, contract management, payer management, and break fixes.
• Creates training materials for all Revenue Cycle impacting departments regarding Revenue Cycle processes.
• Analyzes payer performance against payer contracts, alerting Revenue Cycle Leadership of issues.
• Troubleshoots payment impacting payer issues with payer network management staff.
• Communicates with Regional Accountable Entities regarding locations enrollment, including new and termination documentation.
• Participates in enrollment progress update meetings with front-end operations and compliance teams; provides and distributes status information to stakeholders and maintains detailed notes about enrollment progress in provider enrollment database.
• Submits provider change and termination requests to all health plans in a timely manner. Informs commercial and government payers and internal SCL stakeholders of provider and clinic updates.
• Collaborates and coordinates with Recruitment in the onboarding and off-boarding of providers.
• Completes all payer re-credentialing requests and demographic/roster requests. Completes payer roster comparisons with internal SCL roster twice a year.
• Builds strong, communicative, collaborative relationships with payer representatives.
• Participates in team work sessions to address Epic hold and denial work queues and communicate issues and trends to leadership.
• Collaborates with Accounts Receivable to identify claim denial trends and with Coding to identify trend denials related to CPT codes and specific payer types.
• Maintain a working knowledge of Medicare 855 and Colorado Medicaid enrollment requirements and regulations. Ensure that appropriate education and communication is conveyed to organizational stakeholders.
• Maintains industry best practices for government, commercial, and pharmacy payer enrollments and ensures compliance to government rules and regulations.
• Reports out Provider Enrollment Epic work queue metrics to management.
• Conducts root-cause analysis to identify and resolve provider enrollment claim issues to minimize denials and reduce key metrics such as AR and write offs related to provider not on plan.
• Monitors and proactively identifies, researches, and proposes solutions to address market trends.
• Executes and coordinates provider enrollment and related duties for clinic growth and expansion
• Obtains and verifies organizational NPI NPPES accounts are up-to-date and accurate with appropriate medical group taxonomy information.
• Coordinate with Stride clinical operations and facilities to update and/or obtain medical group licensure with all payers.
• Documents, educates, and shares knowledge interdepartmentally of provider enrollment changes and issues with all payers. Creates and implements streamlined and standard processes and workflows.
• Maintains Provider Enrollment database.
• Execute large enrollment provider/payer projects.
• Other duties as assigned.

STRIDE Values

• Integrity: Doing the right thing even when no one is watching.
• Compassion: Meeting patients where they are with empathy.
• Accountability: Following through on our commitments.
• Respect: Valuing human dignity.
• Excellence: Embracing a growth mindset and striving for continuous improvement.

Education and Experience:

• High school diploma or GED required. Associate of Applied Science (AAS) or Associate of Arts (AA) degree preferred.
• Three (3) years previous work experience in a healthcare is required.
• One (1) year work experience in the build and update of Epic systems is required.
• Previous work experience in revenue service center is preferred.
• Previous work experience with provider enrollment and/or credentialing is required.

Skills & Expertise:

A successful candidate is one that is extremely organized and pays great attention to detail. The candidate must be a motivated, self-starter that is willing to take the initiative to overcome challenges and resolve problems. Candidate must communicate clearly and effectively in both verbal and written communication. Must be dedicated to implementing and documenting standardized processes in coordination with other organizational stakeholders.

Tools you’ll use: Printer, multi-line telephone systems, fax machine, copy machine, calculator, mobile telephone, electronic medical records, secure messaging.

Working Environment and Physical Activities:

Office environment within a clinical setting. Enters data into computer programs via computer, mouse and keyboard. Moves about the office environment and occasionally to other locations. Moves/transports objects up to 25 lbs occasionally. Communicates information to others. Discerns/analyzes information from others to assist in decision making.

At STRIDE Community Health Center, we value a strong and collaborative work environment. To ensure a successful integration into our team, we implement a 90-day probationary period for all new employees. This timeframe is designed to evaluate performance and assess cultural alignment within our organization. It offers both the employee and the employer the opportunity to determine if the role is a mutual fit, promoting long-term success and satisfaction in your career with us. Join our dedicated team and contribute to our mission of providing quality health care to our community!

Hybrid Schedule: 2 days onsite, 3 days remote (subject to change) - Full Time

We offer a competitive salary of $64,000 - $91,000, depending on your experience.

This range reflects STRIDE’s good faith estimate of potential compensation at the time of posting. The final salary for the selected candidate will be determined based on several factors, including experience, education, budget, internal equity, specialty, and training.

Why STRIDE?

Join us for a fulfilling career with a comprehensive full-time benefits package that promotes professional growth, well-being, and financial security, including:

• Medical, dental, and vision coverage
• Paid time off (PTO) and holidays
• Health Savings Account (HSA) and Flexible Spending Account (FSA), including dependent care options
• 401(k) with matching
• Work-life balance
• NHSC Loan Repayment
• Tuition reimbursement and/or Continuing Medical Education (CME)
• No nights, weekends, or major holidays
• Employee Assistance Program (EAP)
• Employee Discounts on top attractions, hotels, more

STRIDE conducts background checks, including criminal history, education, license and certification.

STRIDE is an equal opportunity employer, and all qualified applicants will receive consideration for employment without regard to any characteristic protected by law.

STRIDE complies with the Americans with Disabilities Act, providing reasonable accommodations as needed.

Health and Safety Commitment:

To ensure the safety of our patients, staff, and communities, all new hires at STRIDE must receive an annual flu shot or provide an exemption, as well as undergo tuberculosis screening and testing.

Applicants will be considered until the position is filled.