Credentialing Specialist | Cornerstone Service Center | Eagle, ID

Ensign Group OH (Ohio)
We are building a World Class Service Center in Boise, ID and invite you to join a Team of people who are committed to a core objective of supporting life changing service and providing professional expertise to the agencies we support and their leaders.

About the Company

Cornerstone is one of the most dynamic and progressive companies in the rapidly expanding home health, hospice, and home care industries. Affiliates of Cornerstone now operate 31 home health, hospice, and home care agencies across eleven Western states and we expect this growth to continue. These agencies have no corporate headquarters or traditional management hierarchy. Instead, they operate independently with support from the "Service Center," a world-class service team that provides the centralized clinical, legal, risk management, HR, training, accounting, IT and other resources necessary to allow on-site leaders and caregivers to focus squarely on day-to-day care and business issues in their individual agencies.

About the Opportunity

Responsible for the credentialing process for all Cornerstone Home Health, Hospice, and Private Duty agencies. Works closely with Post-Acute Continuum Care (PACC) and Managed Care (MC) Resources to identify new network opportunity's, develop and maintain alternative care and payment model systems, tools, and processes.

Duties and Responsibilities

* Work independently to ensure all payer contacts for home health, hospice, and private duty agencies are properly credentialed in new and existing payer contracts.

* Initiate and develop best practice for credentialing process for most efficient credentialing processing.

* Work with MAC to maintain payer contracts and contract summaries.

* Communicate credentialing and contract needs to agency leadership team.

* Update all payer contracts in contract payer summaries in a timely manor.

* Work directly with MAC to ensure training and support to agency leadership team.

* Support PACC Director to Identify new network opportunities by tracking current participation alternative payment models and formulate recommendations to PACC and MC resources.

* Exercise independent judgment and discretion in the research, development, and maintenance of alternative care and payment model systems, tools, and processes taking into considering quality, patient experience and financial impact.

* Support PACC Director and MC Resource to design innovative education presentations for home health agencies, potential network partners, current network partners, and the healthcare community.

* Analyze PACC performance outcome metrics utilizing the PACC Tracking tool to identify areas requiring performance improvement plans.

* Notify facility IDT and continuum partners regarding outcome metrics falling below the quality performance threshold.

* Assist PACC Director in coordinating with agency IDT to identify PACC performance outcome metric goals and thresholds for requiring performance improvement plans.

* Create, track, maintain and report on data for outcome metrics in alternative payment models participation, managed care contracts, and on company, cluster, and agency outcomes for Star and Home Health Compare.

* Provide guidance and support for innovative payment model agreements, including specific performance outcome metrics, provider gain sharing, physician alignment and value based purchasing/pay for performance models.

* Maintain current knowledge of alternative payment models (e.g., episodic payments: ie., bundle payments for care improvement initiative, accountable-care organizations, managed care bundling and clinically integrated networks, etc.) and health care policy as it relates to continuum provider services, regulatory compliance and alternative payment models.

* Attend quarterly PACC Resource meeting, weekly PACC WebEx and partner with PACC Resource team where needed to develop continuum best practice tools and processes.

Qualifications

* Qualified candidate must have a bachelor's degree in a healthcare related field or 3 + years in a similar position. Basic understanding of the post-acute care continuum, health care policy and alternative payment models (BPCI, ACO, Managed Care).

* Strong working knowledge of excel to develop and maintain tracking tools both financial and outcome based.

* Must possess skills needed to collaborate and strategize with all continuum partners to build seamless quality transitional care processes across multiple settings within the continuum.

* Basic knowledge base of the evolving changes within the healthcare industry. Including Accountable Care Organizations, Bundled Payments for Care Improvement Initiative, transitional care models and consortiums, Long-Term Care Reform Proposal, IMPACT Act, current and future regulatory compliance policy, Comprehensive Care for Joint Replacement Initiative, Hospitals Improvement for Payment Act, Bundling and Coordinating Post-Acute Care Act, MedPAC Post-Acute Payment Report.

* Must understand how post-acute care continuum performance has a direct impact upon agency, cluster, company and organizational strategic growth objectives.

* Must be highly professional in demeanor.

* Able to think outside the box.

* Strong analytical and financial skills, and communication skills. Must be a team player, critical and creative thinker, and able to build relationships across the team in order to push PACC initiatives forward.

Additional Information

Compensation: Base on experience.

Type: Full Time

Location: Eagle, ID

About The Ensign Group

We are proud to be affiliated with The Ensign Group, Inc., an organization formed in 1999 with the goal of establishing a new level of quality care within the health care industry. The name "Ensign" is synonymous with a "flag" or a "standard," and refers to a goal of setting the standard by which all others are measured. We share this vision and our core values with other health care providers affiliated with The Ensign Group, such as skilled nursing, assisted living, urgent care and mobile diagnostics. We all believe that through our efforts, we can achieve a new level of client care and professional competence and set a new industry standard for quality home health and hospice services. You can learn more about The Ensign Group at www.ensigngroup.net.

Cornerstone is an Equal Opportunity Employer. We evaluate qualified applicants without regard to race, color, religion, sex, national origin, disability, veteran status, and other protected characteristics.

The employer for this position is stated in the job posting. Ensign Services, Inc. provides recruiting services for operations in the skilled nursing, assisted living, home health and hospice industries.

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