Medical Credentialing and Contracting Associate

FORTA’S MISSION:

Forta is clearing the path to quality healthcare by delivering the best possible outcomes with the utmost convenience. 1 in 44 children [CDC, 2021] is diagnosed to be on the autism spectrum. Currently, autism support via Applied Behavior Analysis (ABA) is difficult to access and the delivery model must be expanded to provide earlier access to families.

Forta is not only providing ABA services to our clients, but we’re also improving the future of the ABA experience for families by creating software and predictive algorithms that elevate clinicians to work smarter by surfacing the latest and most relevant case data. We are working diligently to continuously improve the patient journey and deliver personalized care by applying smart technology and investing in the growth of our world-class team.

By joining Forta, you will be part of a fast-paced startup that will require quick thinking and willingness to serve in a variety of roles while working collaboratively across departments.

Job Description:

We are seeking a highly organized and detail-oriented professional to join our team as a Credentialing and Contracting Associate. You will be responsible for carrying out the credentialing and contracting processes for Forta in compliance with legal and regulatory requirements. This is a fully remote position.

Responsibilities:

Credentialing Responsibilities:
– Perform the end-to-end steps to ensure credentialing of Forta’s clinicians with insurance companies and government agencies (“payors”).
– Collect, review, and verify all required documentation, including licenses, certifications, education, training, and work experience.
– Ensure compliance with all applicable regulations, accreditation standards, and organizational policies.
– Maintain accurate and up-to-date credentialing files for each clinician, including updating CAQH profiles for each clinician.
– Monitor expiration dates of credentials and initiate renewal processes as necessary.
– Perform regular follow-up calls and email communication with payors to expedite the credentialing process.

Contracting Responsibilities:
– Perform the end-to-end steps to ensure Forta acquires group contracts with payors.
– Ensure compliance with legal requirements and organizational policies.
– Track contract expiration dates and initiate renewals or amendments.
– Maintain a centralized contract management system for accurate filing and accessibility.
– Escalate and resolve contract-related issues promptly.
– Communicate contract updates in a timely and effective manner.

Payor Relations:
– Communicate with insurance companies and government agencies to verify credentialing requirements and obtain necessary authorizations.
– Liaise with payors to resolve credentialing and contracting issues.
– Stay updated on payor policies and billing requirements for compliance and optimal reimbursement.

Communication and Collaboration:
– Build and maintain relationships with internal departments, external agencies, and payors.
– Collaborate with internal teams for seamless operations.
– Identify areas for process improvement and implement solutions to enhance efficiency and effectiveness.

Requirements/Qualifications:

– Bachelor’s degree is required, specialization in healthcare administration, business administration, or a related field is preferred but not required.
– As this is a fully remote position, you must have a reliable internet connection and be able to provide your own computer and equipment.
– Strong attention to detail and ability to manage multiple tasks simultaneously.
– Excellent organizational, communication, and interpersonal skills.
– Proficiency in using Google Workspace.
– Ability to navigate complex systems and processes.

Send us your CV and answers to these questions:

1. Describe a complex problem you encountered in a previous role and how you approached solving it. What was the outcome?
2. What values do you believe are important for a successful work environment? How have you demonstrated these values in your previous experiences?
3. Describe a situation where you had to work under tight deadlines or pressure. How did you manage your time and priorities to meet the goals?
4. Tell us about a time when you had to quickly learn a new skill or adapt to a new process or system. How did you approach the learning process, and what was the result?

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Flexible Time Off (FTO): Unlimited time off! Great for personal, sick, and mental health days.

We are looking for you! A driven, innovative, client-focused individual to join our team as we innovate the care and tools available to neuro-diverse families. If this position sounds like the opportunity you have been searching for, we want to speak with you!

We look forward to working with you!

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All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status. Forta is a Drug Free Workplace/ EO employer – M/F/Veteran/Disability