Contracts Team Lead

Join a Leader in Home Healthcare

At Rotech Healthcare Inc., were more than a medical equipment providerwere a trusted partner in patient care. As a national leader in ventilators, oxygen therapy, sleep apnea treatment, wound care, diabetic solutions, and other home medical equipment, we empower patients to manage their health from the comfort of home.

With hundreds of locations across 45 states, our team delivers high-quality products, exceptional service, and compassionate support that helps patients live more comfortably, independently, and actively. Whether you're a clinician, technician, or healthcare administrator, your work at Rotech directly improves lives.

Explore more about our mission and services at Rotech.com.

Contract Team Lead

We are seeking a dedicated Contract Team Lead to join our Contract Administration Department team. In this position your primary 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 Rotechs 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 Rotechs 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, BCCs, 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 states 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

Supervisory Responsibilities

None

Employment is contingent on

Background investigation (company-wide)

Drug screen (when applicable for the position)

Valid drivers 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

Helpful, knowledgeable and polite while maintaining a positive attitude

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

Work Environment

Office environment

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)