Payer Contracting and Credentialing Specialist

About the role

Origin Therapy is a pediatric therapy company. We give speech, occupational, and physical therapists a way to launch and run their own private practice, with the business side handled for them: referrals, scheduling, charting, billing, and insurance. You set up the payer contracts for Origin in new states. That means filling out the applications, sending them in, and then staying on the payer until the contract is signed and we can actually bill against it. We’re looking for people with experience setting up payer contracts from scratch. If you haven’t set up a contract in a new state for a company, this role is not for you.

Responsibilities

• Send in the applications. Fill out and submit payer applications and letters of intent, through portals, by fax, or through a rep. Write down a confirmation number every time you send something.
• Follow up until they answer. This is most of the job. Every open application has a next step and a date on it, and you check in every three days. When a payer goes quiet, you work up the ladder: your rep, then provider relations, then the network manager, then the state insurance department.
• Enroll us with Medicaid. Get Origin enrolled with each state's Medicaid program and its managed care plans, and send them our provider rosters.
• Set up the rate conversations. Never let us sign without seeing the fee schedule first. Read the whole contract, not just the rate per code. Visit limits and which fee schedule applies are where we lose money.
• Keep our paperwork current. Every contract depends on up-to-date CAQH profiles, state licenses, malpractice certificates, and Medicaid IDs.
• Make sure a signed contract actually works. Signing is not the finish line. Our providers still have to be added to the contract, claims routing has to be turned on, and the payer's own system has to show us as in-network. A contract we cannot bill against is worth nothing.
• No team under you. You get a direct line to the CEO, an expert advisor for the