Managed Care Contracts/Credentialing Specialist

Job Summary

We are seeking a dynamic and detail-oriented Managed Care Contracts and Credentialing Specialist to join our healthcare team. In this vital role, you will oversee the management of healthcare provider contracts, ensure compliance with industry regulations, and facilitate the credentialing process for medical professionals. Your expertise will help streamline provider enrollment, maintain accurate records, and uphold the highest standards of healthcare compliance. This position offers an exciting opportunity to contribute to a mission-driven organization dedicated to delivering exceptional patient care through efficient managed care operations.

Duties

• Manage and negotiate healthcare provider contracts, ensuring alignment with organizational goals and regulatory standards.
• Review and process medical re/credentialing applications, verifying credentials in accordance with industry standards.
• Maintain up-to-date knowledge of health regulation policies, CMS (Centers for Medicare & Medicaid Services) guidelines, and state healthcare regulations to ensure compliance across all contracts and credentialing activities.
• Utilize healthcare software applications and databases to track credentialing status, contract details, payer enrollments, and compliance documentation.
• Coordinate with medical offices to facilitate provider enrollment with various health insurance payers, including CMS and commercial insurers.
• Conduct thorough review of credentialing applications for accuracy, completeness, and adherence to accreditation standards.
• Ensure confidentiality of sensitive information while managing large volumes of data related to provider credentials and contractual agreements.
• Support ongoing compliance efforts by preparing documentation for audits related to healthcare accreditation standards.

Qualifications

• Proven experience in managed care, medical credentialing, or healthcare contract management.
• Strong administrative experience within healthcare settings, including familiarity with medical terminology and healthcare compliance requirements.
• Proficiency in Microsoft Office Suite (Word, Excel, Outlook) and experience with medical credentialing software or healthcare software applications.
• Knowledge of medical payer enrollment processes and health insurance policies.
• Familiarity with CMS regulations, Medicaid/Medicare policies, and state healthcare regulations governing provider credentialing.
• Database management experience with the ability to handle confidential information securely.
• Excellent organizational skills with attention to detail when reviewing credentialing applications or managing contract documentation.
• Ability to interpret complex health regulation policies and ensure organizational adherence to accreditation standards such as NCQA and JCAHO.

Join us in a role that empowers you to make a meaningful impact on healthcare delivery! We value energetic professionals who thrive in fast-paced environments and are committed to maintaining the highest standards of compliance and quality assurance in managed care operations.

Pay: $22.00 - $29.00 per hour

Benefits:

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

Application Question(s):

• Do you have the ability to work in our office M-F 8:00 AM-5:00 PM?

Experience:

• MCO contracting /credentialing: 1 year (Required)

Work Location: In person

Salary : $22 - $29