Contracting Credentialing Specialist

Job Description

Job Description

Overview

Contract Specialist is responsible for payor contracting. Skilled in negotiating and renegotiating payor contracts and single case agreements to optimize reimbursement and profitability.

Proficient in organizing and maintaining contract documentation, insurance enrollments, and credentialing files to ensure accessibility and accuracy for all stakeholders. Has effective communication with providers and healthcare organizations, ensuring timely completion of enrollment processes and maintaining up-to-date records of insurance participation.

Responsibilities

• Engage with payors through in-person meetings, phone, virtual, and email to foster strong relationships and negotiate agreements that align with organizational goals and maximize value.
• Negotiate and renegotiate payor contracts and single case agreements to enhance profitability and ensure alignment with current reimbursement standards.
• Manage contract re-credentialing processes to prevent coverage lapses and maintain compliance.
• Organize, store, and maintain contract documentation to ensure accessibility and transparency for all stakeholders.
• Maintain accurate and up-to-date credentialing data for all providers, supporting both initial and re-credentialing efforts.
• Respond to credentialing and privileging inquiries from healthcare organizations in a timely and professional manner.
• Follow up with payors to ensure timely submission of required information and completion.
• Track and update provider participation across insurance plans, including effective dates and plan-specific requirements.
• Perform provider re-credentialing in accordance with individual insurance plan guidelines

Qualifications

· Associates Degree in business or health related field preferred

· Three years Contracting and Provider Enrollment experience preferred

· Must be an organized “self-starter” requiring little supervision in order to focus on and accomplish tasks