About Rotech Rotech Healthcare Inc. is a national leader in providing ventilators, oxygen, sleep apnea treatment, wound care solutions, diabetic solutions and home medical equipment. We help patients lead a more comfortable and productive life by keeping them engaged in their care and empowering them to manage their health and treatment at home. Rotech provides high quality medical products, services and outstanding customer care through hundreds of locations across 45 states. For additional information, visit our company homepage Rotech.com Overview and Responsibilities Summary We are seeking a dedicated Contract Team Lead to join our Contract Administration Department team. In this position your primarily responsibility is to serve as the subject matter expert for one or multiple functions within the Contract Administration Department (CAD). The functions include the creation, maintenance and administration of both Contracted and Non-Contracted Payers that Rotech provides services to; Managed Care, Government Contracts, Hospice, Skilled Nursing, Professional Service Agreements, Patient Pay Agreements and Rotech’s retail pricing contracts. Responsible for the complete credentialing process as defined by payer credentialing policies and procedures including provider manuals, contract language and requirements to ensure Rotech compliance and contract performance. Other responsibilities also include re-credentialing, LANs, COIs Contract/ Payer Rules, guidelines and pricing methodologies; ensuring revenue is maximized. Essential Duties and Responsibilities Administration of contracts; complete review of payer contract language, policies and procedures, provider manuals, billing rules and guidelines Analyzes monthly trend reports (held item, adjustment analysis) to identify additional research and/or updates required to Contract/ Item Master Assigns and updates necessary contract classifications for Managed Care/Government Reporting purposes Assist with projects at the Billing Center (BCC) when access to older billing rules, HCPCs, ICD9, etc. is required to process claims in arrears (monitor window of claims processing to ensure no inaccurate billing occurs during project time frame) Assists in creating and maintaining Rotech’s Supplier Diversity Database including yearly mailing to all Rotech vendors Communicates with Purchasing on appropriate base contract pricing Communicates with the BCC, Central Intake, Sleep Central and locations regarding contract changes and/or updates including distribution of reference guides Conducts and leads calls with payers regarding changes and/or updates to payer rules, processes, guidelines, pricing methodologies and credentialing practices Conducts and leads monthly team meetings to review top account issues, denials, adjustments and held item errors and recommends quarterly review topics to the managed care team Conducts and leads team meetings as needed to review process and or system changes that effect functions within the CAD Creates and maintains job aids and training materials as it relates to contract and credentialing functions and systems used within CAD Creates FOIA requests as appropriate Files yearly government reports such as Subcontracting report, CCR registration and Vets-100 Maintains all updates or changes to these requirements as submitted by locations, BCC’s, and/or payers Maintains Contract Quick Reference Guides on the Rotech Home Page Maintains current location database spreadsheet and COIs Maintains database of contracts within shared drive, e-Intake and Contract Logix Maintains database of credentialing/re-credentialing within Laser Fiche and shared drive Maintains location dashboard information so assigned contracts appear on appropriately contracted locations Maintains monthly LANs updates and appropriate payer notification Maintains pricing and other updates within the on-line ordering system Maintains timely filing requirements outlined in Contracts to ensure claims drop as required by Contracted Payers into the timely filing cue within the billing center Monitors the release of solicitations daily and maintains a list of active solicitations within company database Obtains, researches and updates all Medicare, Medicare Non-Assigned and state’s Medicaid contracts as new HCPCS, Pricing, Modifiers, Certification requirements are published and available on various state websites, government payment boards, etc. Performs maintenance and administration of HCPCS and ICD-9 codes as updated, changed or published by Medicare to ensure appropriate HCPCS and ICD9 are available for predetermined effective date and claims processing Receives, researches and validates payer claims addresses and designates applicable billing requirements that will print on all Rotech paper claim forms Research and applies internal company rules and policies to all items set-up on contracts, Sales Commission Points, Assignment of Benefits Requirements, Coverage type for Rent to Cap items, product category, product class inventory track able items, eIntake viewable items, eIntake product kit set ups and manufacturer requirements Research of competitor information Researches and verifies contract requirements through various sources (billing/payment history, payor provider support, etc.) when there are no contracted requirements on file Updates all Private Insurance Contracts that are on schedule with Medicare HCPCS, Pricing, Modifier and Certification updates (as provided on payor profile, through contracting department, or payor payment boards/websites, etc.) Performs other duties as assigned Qualifications Employment is contingent on Background investigation (company-wide) Drug screen (when applicable for the position) Valid driver’s license in state of residence with a clean driving record (when applicable for the position) Education and/or Experience Four year degree or equivalent combination of college education and/or related work experience in healthcare, billing, and/or industry contracts Lead/Supervisory experience desired Knowledge of Healthcare Contract Language and the ability to read and interpret Contract requirements and guidelines Minimum of five years directly-related experience in the medical industry working with HCPCS, CPT and ICD-9 Codes Paralegal certificate desired Skills, Knowledge and Abilities Effectively communicate in English; both oral and written, with employees and vendors to ensure questions and concerns are processed in a timely manner Identify and resolve potential financial risk items/situations and think critically and analytically Interpret a variety of instructions in a variety of communication mediums Knowledge of Industry Contracts and medical billing Maintain confidentiality and practice discretion and caution when handling sensitive information Medical terminology Multi-task along with attention to detail Self-motivation, organized, time-management and deductive problem solving skills Solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists Speak clearly and persuasively in positive or negative situations; listen and obtain clarification; respond well to questions Work independently and as part of a team Write clearly and informatively; present numerical data effectively; read and interpret written information Physical Demands Requires sitting, walking, standing, talking or listening Requires close vision to small print on computer and or paperwork Machines, Equipment and Technical Abilities Email transmission and communication Internet navigation and research Microsoft applications including but not limited to Word, Excel, Power-Point, etc. Office equipment; fax machine, copier, printer, phone and computer Innovative Medical Billing System (IMBS) preferred Rotech Information Benefits Generous paid time Off and paid holidays Overtime pay for non-exempt hourly positions based on business needs Commission for Account Executives Fixed and variable rate car reimbursement for Area Managers and Account Executives Employee discount program Employee recognition program Bonus and incentive opportunities Mileage reimbursement (when applicable for the position) Telephone reimbursement (when applicable for the position) EAP 401k Medical, Prescription, Dental and Vision HSA and FSA/Dependent Care FSA Life Insurance, Disability, Accidental death, Identity protection and Legal services Meru Health Mental health and Mercer SmartConnect Medicare programs Livongo Diabetes and High Blood Pressure programs Healthcare Bluebook and RX Savings solutions programs HEPB and TB vaccinations Make the Right Move and Submit your Resume Today! The hiring manager reviews resumes and contacts applicants that have related experience to the applied position. To view the status of a position that you submitted your profile to, Sign into your account. All positions are posted for a min of 5 days and positions are opened until filled with a qualified applicant, generally no greater than 200 days. We appreciate your interest in Rotech Healthcare Inc. Equal Opportunity Employer of Minorities, Females, Protected Veterans and Individuals with Disabilities. Rotech Healthcare Inc. recruits, employs, trains, promotes, transfers, separates from employment and compensates employees without regard to membership in, association with, or perception of race, color, age, gender, gender identity, religion, creed, national origin, ancestry, citizenship, marital status, veteran status, sexual orientation, physical or mental disability, pregnancy or any other personal characteristic protected by applicable federal, state and local laws governing nondiscrimination in employment in each locality where Rotech has employees.