Credentialing & Contracting Specialist

Job Description

Job Description

Essential Duties and Responsibilities:

• Main Job function entails filling out and processing credentialing, contract, revalidation and other payer documents for New In-Network agreements, renegotiations, and routine upkeep.
• Assist with processing LOIs, applications, contracts, and credentialing for our company with new payers/health plans.
• Work in a B2B business development capacity on targeted potential and existing contracts as assigned, starting from initial contact, follow-up, escalations, meetings, and negotiations with the goals of turning Out-Of-Network payers into In-Network contracts, rate increases, patient steerage, and maintaining payer relations and contracts.
• Process, send, and follow-up on letters of interest, communications, applications, credentialing information, amendments, and other payer documents required to complete the sales cycle.
• Schedule, attend, execute remote (web based) and in-person meetings with targeted potential and existing contracted providers nationwide to further the company contracting footprint and deepen payer relationships.
• Assist with processing LOIs, applications, contracts, and credentialing for our company with new payers/health plans.
• Detail orientated, efficient, and produces error free, timely work.
• Track credentialing and recredentialing deadlines within Company task tracking platform (Currently Sales Force and Share Point)
• Monitor and track submissions and status changes with payers and update internal records.
• Support and Troubleshoot Network Status issues communicated by internal team members directly with our Payer Partners via email, phone, and web portals.
• Communicate updates to existing payers and internal team members.
• Ensure all documents for signature, including all credentials, amendments, and all material correspondence are escalated to the appropriate person within 1 business day of receipt for completion.
• File all returned amendments and contracts from the payers/plans within the company’s current filling system.
• Support executive leadership and colleagues with special projects and perform other duties as assigned.

Minimum Qualifications:

• 3+ years of Healthcare Credentialing Experience.
• College Degree in a related field preferred but not required.
• Highly self-motivated, able to drive pipeline leads from first contact to execution, business development projects from planning to completion.

Preferred Knowledge, Skills and Abilities:

• Proven work experience as a Credentialing Coordinator or similar role.
• Proven work experience in payer contracting, relationship development, and rate negotiations.
• Durable Medical Equipment (DME) knowledge a plus.
• Excellent verbal and written communication skills.
• Expertise with Microsoft Office products and Salesforce.
• Proficient touch-typing skills.
• Ability to focus for extended periods.

You will be expected to work during normal business hours, which are Monday through Friday, 8:00 a.m. – 5:00 p.m. Please note this job description is not designed to cover and/or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties and responsibilities may change at any time with or without notice