Contracting and Credentialing

Overview

Join our dynamic healthcare team as a Contracting and Credentialing Specialist, where your expertise will drive the seamless onboarding and compliance processes essential to delivering exceptional patient care. In this role, you will manage the intricate procedures of healthcare provider credentialing, payer enrollment, and contract management, ensuring adherence to industry standards and regulatory requirements. Your proactive approach will support our mission to maintain the highest levels of healthcare quality, compliance, and operational efficiency.

Responsibilities

• Oversee the complete medical credentialing process, including reviewing credentialing applications for accuracy and completeness in accordance with NCQA (National Committee for Quality Assurance) standards and JCAHO (Joint Commission) accreditation requirements.
• Manage medical payer enrollment activities, ensuring timely registration with insurance companies, including CMS (Centers for Medicare & Medicaid Services), to facilitate provider participation in health plans.
• Maintain and update provider databases using healthcare software applications and medical credentialing software to ensure data integrity and regulatory compliance.
• Review contracts with healthcare providers, ensuring all terms meet regulatory standards such as CMS regulations and state healthcare policies.
• Coordinate with providers and payers to resolve credentialing discrepancies or issues promptly, supporting smooth contract execution and provider onboarding.
• Ensure compliance with healthcare regulations including CMS guidelines, state healthcare regulations, health insurance policies, and accreditation standards such as NCQA and JCAHO.
• Handle confidential information with utmost discretion while managing large volumes of data related to provider credentials, contracts, and payer enrollments.

Requirements

• Proven experience in managed care environments with a strong understanding of healthcare administrative processes.
• Demonstrated knowledge of medical credentialing application review processes and healthcare compliance standards.
• Proficiency in Microsoft Office tools (Word, Excel, Outlook) along with experience using medical credentialing software and healthcare software applications.
• Familiarity with medical payer enrollment procedures, health regulation policies, and CMS regulatory compliance requirements.
• Strong understanding of medical terminology, database management practices, and healthcare accreditation standards such as NCQA and JCAHO.
• Excellent organizational skills with the ability to manage multiple tasks efficiently in a fast-paced setting.
• Prior experience in contract management within a healthcare setting is highly desirable.

Join us to be part of a dedicated team committed to excellence in healthcare administration! Your expertise will help ensure our providers are credentialed efficiently, compliant with all regulations, and ready to deliver outstanding patient care every day.

Pay: $16.00 - $20.00 per hour

Expected hours: 40.0 per week

Benefits:

• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Work Location: In person