[Hiring] Facility Onboarding and Payer Relations Manager @Evoraa Healthcare

Role Description

The Facility Onboarding & Payer Relations Manager is responsible for verification of benefits, provider and facility onboarding and documentation, credentialing, and payer contracting. This position also supports the RCM Director on special projects and problem accounts from a collections standpoint.

In this description, “leadership” means the RCM Director and the Chief Operating Officer (COO).

Key Responsibilities

• Verification of Benefits (VOB) Leadership
  • Own the full VOB workflow, from inquiry to completed verification.
  • Lead, coach and evaluate VOB Team Leads, and through them the VOB staff: hiring, training, scheduling, performance reviews and corrective action.
  • Set and monitor turnaround-time and accuracy standards; audit a sample of VOBs each month.
  • Build and maintain VOB scripts, payer cheat sheets, and checklists by level of care (detox, residential, PHP, IOP, OP).
  • Track trends in out-of-network benefits, deductibles and authorization rules, and share them with leadership.
  • Work with the RCM team to trace denials back to front-end errors and fix the process.
  • Manage VOB tools and EHR workflows, such as Kipu, eligibility portals and clearinghouse tools.
• Onboarding and Facility Document Management
  • Own onboarding paperwork for new clinical providers, including licenses, DEA, NPI, CAQH, malpractice, board certifications and background checks or any documents identified as needed to bill out claims successfully.
  • Maintain a central tracker of every expiration date: provider licenses, facility licenses, Joint Commission (JCAHO) accreditation, CLIA, insurance policies and state certifications.
  • Send renewal reminders well ahead of deadlines, typically at 90, 60 and 30 days.
• Compass Revenue Solutions
  • Update payers, CAQH and directories whenever provider rosters, addresses, tax IDs or ownership change.
  • Keep audit-ready files for every provider and facility.
  • Complete payer registrations and EFT/ERA enrollment where available, with a system to track status and keep key stakeholders updated.
• Provider Credentialing and Payer Contracting
  • Lead, coach and evaluate the Credentialing and Contracting staff: hiring, training, scheduling, performance reviews and corrective action.
  • Manage initial credentialing and recredentialing for providers and facilities with commercial, Medicaid and Medicare payers.
  • Track every application from submission to approval, with follow-up on stalled files.
  • Confirm a signed, current contract and fee schedule is on file for every payer and service line.
  • Collaborate with leadership to develop a system for contract negotiations and renegotiations, including analyzing reimbursement against cost and market, preparing rate proposals, and running the renewal calendar.
  • Build out outpatient (OP) group contracts separately from the facility contract, including group NPI and tax ID setup, service-line rates, and correct billing setup.
  • Maintain a contract library with key terms: rates, timely filing limits, authorization rules, appeal deadlines and termination clauses. Inform leadership and department managers of each new or renewed contract with an overview of its key terms for their review.
  • Routinely inform RCM leadership of contract changes so billing and VOB reflect current terms.
  • Evaluate new payer opportunities based on marketplace additions, and single case agreements (SCAs).
  • Routinely check contracted rates against allowed amounts, and escalate discrepancies with carrier contacts where appropriate.
  • Build and maintain a contact list at the insurance carrier level.
• RCM Special Projects and Collections Support
  • Lead the Special Projects staff: assign and prioritize their work, and partner with the RCM Director on special projects, such as payer audits, system conversions, clean-claim initiatives and new service-line launches.
  • Help with problem accounts in Medical Records (MR) and Accounts Receivable (AR): aged AR, underpayments, contract disputes and stuck appeals.
  • Escalate collection issues with payer representatives, drawing on contracting relationships.
  • Find underpayments by comparing paid claims against contracted rates.
  • Track root causes of denials and write-offs that start on the front end, and lead the fixes.
• Leadership and Reporting
  • Report monthly to leadership (RCM Director and COO) on VOB volume, credentialing status, contract pipeline and expirations.
  • Write and maintain policies and procedures for all four areas.
  • Stay current on payer policy changes, parity law, and state and federal regulations that affect behavioral health reimbursement.

Qualifications

• Required
  • Bachelor’s degree in healthcare administration, business or a related field, or equivalent experience.
  • 5+ years in healthcare revenue cycle, with at least 3 years in credentialing, payer contracting or managed care.
  • 3+ years managing people, including supervisors or team leads.
  • Hands-on knowledge of VOB, prior authorization and medical necessity rules for commercial and government payers.
  • Track record of negotiating or renegotiating payer contracts.
  • Working knowledge of CAQH, NPPES, PECOS and payer credentialing portals.
  • Strong organization and deadline tracking across many files at once.
• Preferred
  • Behavioral health or substance use disorder treatment experience across levels of care (detox, residential, PHP, IOP, OP).
  • Experience separating outpatient group contracts from facility contracts.
  • Experience with Kipu or a similar behavioral health EHR.
  • Certification such as CPCS, CPMSM (NAMSS), CRCR (HFMA) or CMPE.
  • Knowledge of the Mental Health Parity and Addiction Equity Act and state licensing rules.

Core Skills

• Negotiation and payer relationship management
• Process design and workflow development
• Coaching and developing team leads

Success Metrics

Within the first 90 days, the Manager will develop success metrics and targets for each area of responsibility and present them to leadership (RCM Director and COO) for approval. Metrics should cover:

• Verification of Benefits (speed, accuracy, assignment strategies)
• Onboarding and facility documents (no lapsed licenses or credentials)
• Credentialing (time to approval by payer)
• Contracting (contracts on file, OP group contracts, renegotiation results)
• Collections support on problem accounts (with the RCM Director)
• Special Projects staff output

Working Conditions

• Remote position.
• Occasional extended hours may apply.
• Access to protected health information (PHI); HIPAA compliance required.