Part-time Payer Contracting & Credentialing Specialist

Part-time Payer Contracting & Credentialing Specialist

Atlantic Health Strategies is seeking a Part‑time Payer Contracting & Credentialing Specialist. In this part‑time, remote role, the Payer Contracting & Credentialing Specialist serves as a specialized operational partner to the leadership team. This position supports commercial and Medicaid contracting, credentialing, reimbursement analysis, and billing compliance reviews. The Specialist plays a critical role in ensuring revenue integrity, maintaining accurate payer enrollments, and identifying financial risks before they impact the organization.

This is a highly analytical role requiring independent judgment. Work is primarily asynchronous and email‑based, with occasional client‑facing Teams meetings.

• Payer Contracting: Prepare and submit commercial and Medicaid organizational applications, manage MCO enrollment and revalidation processes, and maintain contracting trackers and renewal timelines.
• Reimbursement Analysis: Review reimbursement schedules, identify rate variances, and flag contract language that presents operational or financial risk.
• Credentialing Management: Manage Type 2 NPI enrollments and service location additions, ensuring taxonomy alignment with licensed levels of care, and coordinate CAQH updates.
• Revenue Integrity: Conduct focused billing compliance reviews of behavioral health CPT/HCPCS codes and compare billed services against payer policy and fee schedule guidance.
• Risk Mitigation: Identify authorization and documentation risk areas, analyze denial patterns, and recommend corrective actions to leadership.
• Medicaid Research: Research state Medicaid fee schedules and managed care reimbursement structures, interpret provider manuals, and provide written analysis to support expansion into new states.
• Performance Reporting: Summarize reimbursement impact for executive review and maintain accurate, current contracting logs.

• Experience: Minimum 3 years of behavioral health payer contracting experience, specifically with Medicaid MCO enrollment and commercial payer contracting.
• Technical Knowledge: Working knowledge of behavioral health CPT/HCPCS codes, level‑of‑care billing, and ASAM levels of care.
• Analytical
  
  Skills:
  
  Experience analyzing Medicaid fee schedules and payer policy documents to identify variances and risks.
• Communication: Strong written communication skills and the ability to provide clear, written reimbursement analysis within defined timelines.
• Independence: Ability to operate within a defined scope without drifting into claims submission or RCM execution.
• Preferred Background: Multi‑state Medicaid experience and experience in a consulting, MSO, or multi‑facility environment is highly preferred.

• Mission‑Driven: Be part of an organization committed to ethical, high‑quality addiction treatment.
• Flexibility: This role is primarily asynchronous and email‑based, allowing for a flexible schedule (approximately 10 hours per week).
• Professional Impact: A meaningful role where your operational expertise directly supports the financial health and compliance of the organization.
• Compensation: Competitive hourly rate of $50/hour (W2).

• Ability to work remote
  , approximately 10 hours per week
  .
• Minimum 3 years of behavioral health payer contracting experience.
• Direct experience with Medicaid MCO enrollment and commercial payer contracting.
• Working knowledge of behavioral health CPT/HCPCS codes and level‑of‑care billing.
• Strong organizational, documentation, and interpersonal skills.
• Ability to work independently and collaborate effectively via email and occasional Teams meetings.
• Ability to maintain compliance with HIPAA and relevant behavioral health regulations.