Credentialing & Contracting

Position summary:

The Credentialing & Contracting is responsible for overseeing and conducting both credentialing and contracting tasks for Individual providers and/or Provider groups.

Essential Functions:

· Develop and maintain organized system of physical and digital records pertaining to Providers.

· Coordinates and assists with provider/group onboarding activities

· Establish and maintain strong relationships with other departments to ensure credentialing activities are linked appropriately to other applicable areas of the organization.

· Performs contract reviews and contract preparation.

· Oversee quality assurance processes and reporting to ensure compliance with accreditation, federal and state regulatory requirements.

· Oversee quality audits and compliance reporting across all areas of credentialing.

· Assists with training staff on Credentialing and Contracting processes and procedures.

· Other duties as assigned and required.

· Delegation oversight and plan audit activities.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Required Skills:

· Excellent verbal and written communication skills

· General delegation credentialing knowledge.

· PECOS, CAQH, Adobe and Microsoft proficiency with strong Excel experience

· Experience in providing customer service to internal and external customers.

· Experience working with cross-functional teams and influencing without authority.

· Must be able to manage multiple priorities in an efficient manner.

· Ability to work independently and to carry out assignments to completion within parameters of instructions given, prescribed routines, and standard accepted practices.

· Excellent understanding of the organization’s goals and objectives.

· Knowledge of applicable data privacy practices and laws.

· Highly self-motivated and directed, with keen attention to detail.

· A high level of integrity and trust.

· Knowledge of HIPAA, state and federal guidelines on security and transactions.

· Good interpersonal skills and communication with all levels of Management.

Attributes:

• Time management

• Basic research methods

• Proficient in multitasking

• Team Player

Experience and Education:

· Five years previous experience working with Providers and strength in building strong relationships, business administration, or related field

· CPCS certification preferred

Physical Requirements: Must be able to frequently move, stand, sit, bend, stoop, kneel or crouch. Must be able to lift up to 40 pounds occasionally. The noise level of the work environment is quiet to moderate.

Job Type: Full-time

Pay: $16.00 - $20.00 per hour

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Experience:

• Microsoft Office: 1 year (Preferred)
• Microsoft Word: 1 year (Preferred)
• Communication skills: 1 year (Preferred)
• Contracts: 1 year (Required)
• credentialing: 1 year (Required)
• Microsoft Excel: 1 year (Preferred)

Work Location: In person

Salary : $16 - $20