[Hiring] Contracts & Credentialing Manager @Coloplast A/S

Role Description

The Contracts & Credentialing Manager oversees the management and maintenance of all government-funded and commercial insurance contracts, ensuring the company’s continued good standing. This role supervises the submission of new applications, re-credentialing activities, and updates to company demographics. The Manager also leads the implementation of newly enrolled contracts, ensuring that plan information is effectively communicated across departments, to owners, and to external vendors. Additionally, they ensure proper setup of payers in the system, supporting smooth and compliant operations.

Job Responsibilities

• Contracts:
  • Oversee the preparation and analysis of financial data for health plan negotiations.
  • Analyze, manipulate, and interpret reimbursement data using Excel and other reporting tools.
  • Supervise the updating of health plan fee schedules in Excel.
  • Manage the team’s processing of contracting inquiries.
  • Ensure team members handle requests from health plans and third-party payers efficiently.
  • Ensure contracts are entered into the database correctly and securely stored.
  • Supervise the management and updating of contracted health plans and payers.
  • Ensure the team maintains contract-related materials and assists in distributing updates.
• Credentialing:
  • Oversee the processing and completion of credentialing and re-credentialing applications.
  • Supervise the processing of credentialing applications for commercial health plans.
  • Manage administrative tasks for all government-funded and commercial payer accounts.
  • Act as the administrator for state certifications/registrations.
  • Oversee the management of insurance reimbursement fee schedules in the Brightree Database.
  • Ensure the team maintains compliance with all relevant regulations and internal policies.
• Compliance, Policy & Regulatory Oversight:
  • Proactively monitor and stay current on federal, state, payer, accreditation, and industry regulations.
  • Assess regulatory and payer policy changes for operational impact.
  • Develop, implement, maintain, and periodically review departmental policies and procedures.
  • Partner with internal stakeholders to establish and strengthen compliance controls.
  • Serve as a subject matter expert on contracting, credentialing, and compliance standards.
  • Identify opportunities for process improvement and standardization.
• Team Management & Leadership:
  • Manage the team in their daily responsibilities.
  • Facilitate reoccurring one-on-one meetings with applicable staff.
  • Lead monthly team meetings and coordinate training sessions.
  • Manage department staffing needs, including hiring and performance reviews.
  • Approve timecards and PTO requests.
  • Monitor and enhance individual and team performance.
• Collaboration & Culture:
  • Serve as a liaison between internal and external parties.
  • Foster a collaborative work environment across all functional areas.
  • Foster an environment of teamwork, recognition, and engagement.
• Other:
  • Perform other duties and responsibilities as assigned.

Qualifications

• Exhibits and models strong leadership skills, integrity, and reliability.
• Strong communication and conflict resolution skills.
• Excellent customer service skills and professional attitude.
• Ability to effectively train and develop employees.
• Strong ability to collaborate effectively within a team.
• Strong understanding of fraud, waste, and abuse compliance considerations.
• Strong organizational and analytical skills.
• Experience managing multi-state Medicaid enrollment and revalidation.
• Excellent communication skills and experience working cross-functionally.
• Proficiency in relevant technical tools and software.
• Working knowledge of CMS/PECOS enrollment and revalidations.
• DME/DMEPOS experience strongly preferred.
• Intermediate proficiency in Microsoft Excel.
• Experience with Brighttree, Salesforce, and Smartsheet highly preferred.

Requirements

• High school diploma OR equivalent.
• 3+ years of relevant Contracts & Credentialing experience.
• 1-2+ years of people management experience OR demonstrated experience mentoring and training employees.

Preferred Qualifications

• Bachelor’s Degree in related industry.
• 3-5 years of Contracts & Credentialing within the Durable Medical Equipment (DME) industry.
• 3+ years of people management experience.
• Knowledge of Salesforce, Brightree, and MS Office products.

Benefits

• Comprehensive medical, dental, and vision coverage for you and your family.
• Access to company-sponsored wellness programs and mental health resources.
• Paid leave for qualifying events, and generous parental leave.
• Health Savings Account (HSA) with employer contributions.
• Competitive 401(k) with company match and financial planning services.
• Hybrid and onsite employees work from a state-of-the-art facility.
• Flexible work options, generous PTO plan, and summer hours.
• Ongoing learning and career growth opportunities.
• Join a Top Workplace, as recognized by USA Today and the Milwaukee Journal Sentinel.