Contracting & Credentialing Specialist (Remote)

Job Description

Duties and responsibilities

The primary duties for a Contracting/Credentialing Specialist will include but not limited to the following:

Contracting:

· Develop a healthy relationship with the payor Contracting Rep, seek and receive rates asap

· Ensure all applicable documentation and information is provided timely

· Follow up and stay in communication of requests and status

· Identify and provide Manager and/or Supervisor key details within the contract

· Understanding and completing processes of obtaining/maintaining/updating payor contracts

o Finding and identifying payors to contract with

o Negotiating higher rates

o Properly notifying payor of company updates that affect contract

· Accurately interpret/understand the language within the contract

· Assist in the development of department SOP and policies & procedures

Credentialing:

· Ensure all applicable providers are credentialed for all new and ongoing payor agreements by accurately completing and submitting credentialing applications.

· Effectively track the ongoing progress of applicable credentialing for assigned providers/regions/payors and communicate/record those results in a timely fashion.

· Track and maintain all credentials to ensure network status is maintained, and payor/state requirements are met.

· Understanding of necessary ongoing requirements to maintain Provider credentials with regards to payor compliance:

o Ensure all necessary providers are credentialed and added to all applicable locations and contracts in a timely and efficient manner

o Ensure network status is maintained, and payor/state requirements are met

o Collection of necessary documents/info and maintenance of NPI/CAQH/payor validations

· Develop and utilize tools and resources for credentialing data and demographic information for best practice.

· Maintain payor relationships and identify all payor updates and changes.

Complete daily, weekly, and monthly assignments as assigned by Contracting/Credentialing Manager and work special projects as necessary.

Qualifications

The minimum qualifications for the position include a two-year degree from an accredited college or university OR a minimum of two years of experience in healthcare contracting/credentialing or a related field OR an equivalent combination of education and experience.

Employees must have the ability to:

· Exhibit sound and accurate judgement and include appropriate people in decision-making and communication process.

· Adapt to changing situations and have the ability to restructure tasks and priorities as changes occur within the organization on a daily, monthly, and yearly basis.

· Effectively organize and plan work according to organizational needs by defining objectives and anticipating needs and priorities.

· Effectively deal with work-related problems, pressure, and stress in a professional and positive manner.

· Effectively work and collaborate with others toward achieving a common goal.

· Communicate clearly, friendly, and effectively with people inside and outside of the organization.

Must have the skills, knowledge, and abilities necessary to be effective in the specific functional content of a job.

· Must develop and maintain positive relationships with individuals within and outside of their work groups.

· Must be detail oriented and demonstrate accuracy and thoroughness and look for ways to improve and promote quality.

· Must be familiar with Excel and able to filter/sort/find data within reports for tracking

· Must be consistently at work, on time, and take responsibility for completion of assigned job duties.

Physical requirements/ Work Conditions

The physical demands and work environment described are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The work is normally performed in a typical interior work environment. Work involves minimal exposure to physical risks or heavy lifting.

Direct reports

NOTICE: Successful completion of a drug screen prior to employment is part of our background process, which includes medical and recreational marijuana.

By supplying your phone number, you agree to receive communication via phone or text.

By submitting your application, you are confirming that you are legally authorized to work in the United States.

JR# JR249071