Insurance Contracting Specialist

Position Summary

The Insurance Contracting Specialist reports to the Assistant Vice President (AVP) of Payer Relations and Strategy and is a key member of the Insurance Contracting Department. This role is responsible for engaging with healthcare providers and multi-specialty groups within the behavioral healthcare continuum (including eating disorder, mental health and substance use disorder services) in accordance with corporate guidelines to secure Single Case Agreements (SCAs), insurance contracts, and provider credentialing. The Specialist supports organizational access and reimbursement objectives by building provider relationships and ensuring timely, compliant contracting outcomes specific to behavioral healthcare services and levels of care.

Essential Job Functions

• Initiate and manage time-sensitive, one-time payment agreements (Single Case Agreements) for behavioral healthcare services to meet required turnaround times and patient access needs.
• Communicate effectively and professionally with all internal and external stakeholders involved in SCA, insurance contracting, and credentialing processes related to behavioral health providers and facilities.
• Research and analyze the behavioral healthcare market, including provider types, levels of care, and regional access gaps, to identify and engage providers for potential partnerships, beginning with SCAs and/or payer contracts.
• Secure SCAs, insurance contracts, and provider credentialing in compliance with company templates, reimbursement standards, and established process controls specific to behavioral healthcare reimbursement and regulatory requirements.
• Establish, develop, and maintain strong, collaborative business relationships with behavioral health providers, facilities, and multi-specialty groups.
• Provide clear explanations and interpretations related to behavioral healthcare contracting, reimbursement methodologies, and credentialing standards within area of expertise.
• Utilize relevant data and information to identify issues, evaluate options, and resolve problems within scope of responsibility.
• Effectively prioritize, organize, and manage workload to meet strict deadlines in a fast-paced environment.
• Perform other duties as assigned.

Knowledge, Education, and Experience

• High School Diploma or GED required
• Comfort and confidence in making outbound calls to potential new healthcare providers
• Required: Working knowledge of the Behavioral Healthcare industry, including mental health and substance use disorder treatment settings, levels of care, and common reimbursement structures
• Preferred experience in behavioral healthcare operations, contracting, utilization management, admissions, or payer relations
• Healthcare industry knowledge or experience preferred, including one or more of the following:
• Insurance claims and benefits for behavioral health services
• Provider contracting and credentialing
• Electronic Medical Record (EMR) systems (e.g., KIPU)
• CRM or enterprise systems (e.g., Salesforce, SAP)
• Contract negotiation or reimbursement methodologies

Core Competencies

• Proactive, solution-oriented mindset
• Strong phone presence and professional demeanor
• Excellent verbal and written communication skills
• Strong listening, negotiation, and presentation skills
• Ability to multitask, prioritize competing demands, and manage time effectively

Physical Demands:

The physical demands outlined here represent those that are typically required of an employee to successfully perform the essential functions of this position. Reasonable accommodation may be made to enable individuals with disabilities to perform these essential functions.

While performing the duties of this job, the employee is regularly required to do the following:

• Engages in sustained power grasping and pushing/pulling motions
• Exposure to dust, gas, odors, liquids, or fumes
• Intermittent lifting and carrying up to 40 pounds, transporting object usually by hand, arm, or shoulder
• Hand/eye coordination: Performing work using both
• Working with hands: Seizing, holding, and grasping
• Able to lift by raising or lowering an object from one level to another
• The ability to respond quickly to emergency situations, which may involve running or moving rapidly.
• Frequent standing and walking for extended periods, often throughout the entire shift.
• Potential exposure to infectious diseases, bloodborne pathogens, and hazardous materials, requiring adherence to safety and PPE protocols.

Employment Status: Full-Time

Work Location: Hybrid in Irvine, CA

Schedule: Monday - Friday 8 am - 5 pm

Compensation: Pay Range: $24-26/hr.

Arbitration Agreement:

As a condition of employment, all candidates must agree to and sign a pre-employment arbitration agreement. This agreement requires that any disputes arising out of or related to employment with Discovery Practice Management will be resolved through binding arbitration rather than through litigation in court.