DIRECTOR OF CONTRACTS AND CREDENTIALING (Chicago)

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Work Schedule: Monday - Friday (3Xs onsite per week)

Who is Gateway Foundation?

Gateway Foundation, Inc. is a national non-profit dedicated to helping individuals with substance use and mental health disorders. Established in 1968, Gateway provides essential tools and knowledge for recovery, positively impacting hundreds of thousands of lives. Operating through its Community Services, Corrections Divisions, and Corporate Headquarters, the organization is recognized for innovative, effective treatment approaches and maintaining high standards.

Discover a rewarding career where you can find both personal and professional fulfillment while aligning your values with your work. You'll have the opportunity to make a meaningful impact by aiding individuals in overcoming addiction. We pride ourselves on being an organization that values you and strives to be an employer of choice, fostering a vibrant culture that promotes teamwork and professional growth. Your voice matters here; we actively listen to and value our employees' thoughts, allowing you to be part of organizational decisions. At Gateway Foundation, diversity, equity, and inclusion are principles that we embrace in every community we serve. Join Gateway Foundation today and become part of a team dedicated to making a positive difference in the lives of others.

The Director of Contracts and Credentialing is responsible for:

• Oversees and directs activities of the contracts department engaged in contract management, contract negotiations, new contract awards, renewals and amendments and compliance with executed contracts. Responsible for the credentialing and licensing of all programs, physicians and clinicians with all payers and governmental entities. Responsible for coordinating application process to panel physicians with individual insurance companies. Researches competitive reimbursement rates in the industry to make recommendations for appropriate contract revisions. Track and maintain annual contract renewal dates in the appropriate database. Leverages established business relationships to maximize organization’s reimbursement rates for the provision of treatment services.
• Negotiates insurance contracts and rates to align with strategic business objectives; determines appropriate rate structures for new and existing business; leverages established business relationships and uses contract methodologies to maximize the organization’s reimbursement rates.
• Analyzes contract language to ensure regulatory compliance. Responds to inquiries concerning contract and rates and ensures resolution of service issues or problems that occur in connection with business partnerships.
  Develops standardized single case service agreements for all Community Services Division programs to utilize with each non-contracted payer.
• Participates in formulating and development of strategic decisions:
  · Collects, generates and analyzes information for division-wide decision-making process. Analyzes multiple variables affecting growth and improvement opportunities including payment/reimbursement trends, regulatory issues, and service demand.
  · Prepares strategic planning projections to maximize contract dollars or enhance cost allocation.
  · Seeks out new contracts with insurance companies to enable the organizational goal of becoming a preferred provider of substance abuse and mental health treatment services.
  · Coordinates review or development of contracts.
• Acts as an internal consultant and works with:
  · Revenue Cycle Management team and other departments in interpreting and understanding insurance contracts, evaluating reimbursement rates/issues and developing strategies to ensure reimbursement practices fulfill contract obligations.
  · Revenue Cycle Management team and the Utilization Management staff at the treatment centers on denial management process, analyzing trends and problem solving both individual cases and trends. Guides team (-s) in the implementation of the new business contracts.
  · Works collaboratively with the Revenue Cycle, Program Support and Information Services departments in loading the payment rates by payer in the billing system.
• Develops policies and procedures to monitor and enforce contract and credentialing compliance in accordance with Gateway objectives.
  · Advises internal departments and managers on related policies and procedures, and elicits cooperation to adhere.
  · Negotiates contracts for separate billing, establishing the procedures and guidelines and implementing process across the division.
  · Serves as a resource and liaison between Gateway and insurance companies in responding to inquiries concerning contracts and rates.
• Participates in budget planning and development: completes budget analyses and projections, monitors department budget, reviews financial reports to ensure accuracy and correction actions.
• Prepares various reports to document progress toward goals, identify potential barriers to achieving overall goals, improve and enhance efficiency and streamline processes. Makes recommendations to promote achievement of overall goals and business objectives.
• Hires, trains, develops, monitors, and evaluates performance of the Contracts and Credentialing staff.
• Performs other duties as they might be assigned.

Requirements:

• Bachelor’s degree in Business Administration or a closely related field
• Minimum of five (5) years, progressively more related experience in complex, multi-state health settings, experience in behavioral health contracting strongly preferred

Comprehensive knowledge of contract administration and management theories and principles

Knowledge and proficiency in managing and interpreting insurance and managed care healthcare contracts.

Working knowledge of healthcare regulations, policies, and applicable laws; contract negotiations and development

Proficiency in Microsoft Office (Excel, Word, Power Point)

Strong problem-solving and analytical abilities to organize, plan and direct activities and operations, resolve barriers to achievement of program services goals and objectives

Advanced communication and interpersonal skills in order to gather and exchange information in order to negotiate contracts, present information in-person and in writing with a wide variety of influential persons inside and outside the organization, and effectively provide instruction and guidance to direct reports

Critical thinking skills to enhance creativity and problem solving abilities in order to established And meet business goals.

Ability to develop and foster cooperative working relationships with insurance company representatives and prospect business partners, to establish credibility with customers, prospect partners, and management team; to respond to internal or external requests and to develop effective solutions to problems.

Ability to evaluate and interpret insurance contracts, apply standard and innovative contract methodologies to meet the strategic plans of the organization, and plan and execute effective business development opportunities

Physical Requirements:

• Ability to see, hear and speak clearly to prepare and deliver presentations, to negotiate contracts, to analyze data
• Ability to record, proofread and check documents and files for accuracy, to prepare and analyze data and figures, transcribe, and read
• Ability to use a keyboard and video display terminal to receive, retrieve, and/or audit information and data
• Ability to respond to telephones, and to hear and detect alarms and unusual noises
• Ability to travel by car or airplane for business

Benefits at Gateway Foundation:

Health and Wellness:

• Medical, dental, and vision insurance for employees and dependents
• Employee wellness program promoting health and fitness and offering cash-saving premiums
• Employee assistance programs focused on mental health

Financial wellbeing:

• 403(b) Retirement Plan with 3% employer match
• Short-term and Long-term Disability and Life and AD&D Insurance paid for by Gateway
• Flexible Spending Accounts for medical and dependent care
• Public Service Loan Forgiveness (PSLF)

Flexibility and time off:

• 18 paid time off days per year – accrual rates increase with years of service
• 9 paid company holidays
• Work-life-balance

Personal Development:

• Training & Development Programs
• Tuition Reimbursement - up to $5,250 per calendar year
• eLearning access to online courses that provide CEU’s and job-related training
• Clinical Supervision: Formal and informal guidance

Gateway Foundation is an Equal Opportunity Employer: Race/Color/Sex/Sexual Orientation/ Gender Identity/Religion/National Origin/Disability/Vets. Please view Equal Employment Opportunity Posters provided by OFCCPhere .

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