Contract & Credentialing Specialist

United States, USA | Operations | Full-time | Fully remote

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About us 

Working at Boulder

Founded in 2017, Boulder Care is a digital clinic offering long-term support and treatment for substance use disorders. Collaborating across medical, behavioral, and psychosocial dimensions, Boulder’s dedicated Care Teams deliver evidence-based care and help participants work toward their individual goals.  

Boulder's model is grounded in value. Through innovative partnerships with leading national health plans like Blue Cross Blue Shield, Boulder’s progressive payment arrangements realign incentives to reward outcomes and reduce total cost of care. We can unlock billions of dollars for the US health system by ensuring patients who are gravely underserved today have the opportunity to get well.

Backed by world-class investors like First Round, Greycroft, Acumen, and the National Institutes of Health (NIH) with more than $20M in funding, Boulder is in an exciting stage of rapid growth.

 

 Our mission

  • Based in science: Boulder care teams provide comprehensive, evidence-based treatment that is tailored to each individual’s unique needs and goals. Boulder teams also help manage a host of co-occurring conditions, including depression, anxiety, post-traumatic stress disorder (PTSD), Hepatitis C, women's health, and more.

  • Grounded in empathy: We provide unconditional support rooted in harm reduction and trauma-informed care. Patients, peer coaches, and caregivers make important decisions together. Boulder Care focuses on long-term health, happiness, and wellness by addressing non-clinical goals like safe housing, employment, parenting, and financial security just as much as clinical outcomes. This model has resulted in a Net Promoter Score of 91 and 12-month-retention rates that are two times higher than the average outpatient program.

  • Breaking down barriers: Boulder's proprietary technology suite makes care accessible, comfortable, and convenient through secure video, phone, and messaging. We're reaching rural communities of the country, where more than 80% of people have little to no access to buprenorphine (Suboxone) prescribers. Boulder provides low-threshold care that is inclusive, empowering, and heavily influenced by participants' stated preferences and goals. Wherever our patients wish to go, we're grateful to go there together.

 

Our values

  • The people we care for always come first
  • Our opportunity is also our duty, in service to others
  • Share facts to change minds, instill empathy to change hearts
  • Move the industry forward: follow the data
  • Strong individuals, stronger together

 

  About the role

  • As a Contract and Credentialing Specialist, you are a details-driven, organized operator, with a knack for building and maintaining strong relationships with external payors. Under the direction of Revenue Cycle Manager, the Contract & Credentilaing Specialist is responsible for coordination, submission, and oversight of several aspects of Boulder’s provider credentialing and payor contracting process. Along with the Revenue Cycle Manager, you will ensure that all Care Team members possess the necessary credentials and contracts completed to perform their work in compliance with all federal, state, and payor-specific regulations.

  • Make a difference. The devastating impact of the opioid crisis, “war on drugs,” and care gaps for the underserved are at the forefront now more than any time in US history. By bringing care to more people, we are changing and saving lives. Value-based partnerships help move the industry forward toward a more modern, compassionate, and equitable healthcare system.

  • Build your career with talented peers. Boulder brings together a diverse team of expert clinicians, technologists, researchers, and business strategists aligned under a common mission. Boulder’s clinical teams are the leading voices in addiction medicine and industry transformation. Our technology leadership has built products and services that scaled to hundreds of employees and hundreds of millions of end-users. Our team is wholly driven by mission, recognizing that our immense opportunity is also our duty to serve others.

  • Grow with us. Boulder is a Series-A-stage, venture-funded company supported by some of the best investors in the country. Together, we're building a massive business through social impact. According to White House estimates, the opioid crisis cost the US $500 billion in 2015. A member with untreated opioid use disorder (OUD) drives 550% greater healthcare costs to payers than the average member (UHC analysis, 2019). Boulder partners with leading commercial and Medicaid health plans to bring better experiences and effective services to their members, significantly reducing costs and sharing in the economic savings we create.

 

Success in this role

  • Processes boilerplate payor contracts and, as needed, single case agreements, in a timely and accurate manner
  • Continually follows up on contracts and agreements until complete
  • Tracks progress of outstanding applications and reports progress to Revenue Cycle Manager and leadership 
  • Completes and submits credentialing and re-credentialing applications with all payors accurately and in a timely manner.
  • Resolves credentialing issues through collaboration with management, related departments, payors, and others as identified.
  • Ensures submission deadlines are met and submission documentation is maintained appropriately
  • Assist with obtaining needed documentation from providers, such as copies of state licenses, IRS documents, NPI Notification forms, DEA numbers, board certifications, malpractice certificate of insurance, etc
  • Ensures contract, single case agreements, and credentialing documents are stored timely and accurately with credentialing vendor and/or internal platforms
  • Builds and maintains strong relationships with the payor communities, including the government payor community (Medicaid, Medicare, VA, etc)
  • Maintains payor communications distribution list and disseminates internal and external pertinent payor information and/or announcements to Boulder Care stakeholders
  • Performs other duties as assigned or required.

 

Requirements for this role

  • A bachelor’s degree (preferred) or relevant work experience
  • At least 2+ years of professional experience within healthcare provider or payor, within relevant department (contracting, credentialing, network development with managed care, commercial, and/or employer group payors)
  • Demonstrated understanding of how provider contracting and credentialing impacts billing, contracts, and revenue management/collections
  • Understands medical terminology, procedure codes and diagnosis codes as it applies to payor contracts
  • Substantial organizational skills, including multitasking and time-management
  • Reliable customer service, follow-up, and communication skills
  • Ability to work effectively both independently and as part of a team
  • Continuously searches for process improvements to achieve accuracy and efficiencies
  • Strong critical thinking, problem solving abilities, and attention to detail
  • Excellent communication skills with an ability to effectively present to leadership team and other key stakeholders
  • Impact-oriented mindset with a bias for action and a passion for doing the impossible

 

Nice to have but not required:

  • Experience working in a remote environment
  • Knowledge & passion for working in the Substance Use Disorder space
  • Previous experience in a highly collaborative, team-based start-up environment
  • Self motivated with a growth mindset - you seek out learning opportunities for yourself and the team

 

Boulder Care is an equal opportunity employer that recruits, employs, trains, compensates and promotes regardless of race, religion, color, national origin, sex, disability, age, veteran status, and other protected status as required by applicable law. If you believe in our mission to deliver the world’s most advanced opioid addiction recovery plan, you are encouraged to apply.

 

To get more details about who we are and our employee benefits, check out Working at Boulder