Provider Credentialing and Contract Specialist
Provider Credentialing and Contract Specialist
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Job Description
Join us as a Provider Credentialing and Contract Specialist!
Full Time 32 Hours hours per week
**The position is onsite in Auburn MA**
The Contract and Credentialing Specialist is responsible for preparing submitting and maintaining enrollment credentialing and recredentialing documentation for physicians and other healthcare providers. This position builds and maintains relationships internally and externally regarding questions on rates contract terms rate structure and development and reconciliation of contract provisions. This position also manages relationships with external vendors including routine meetings providing references and troubleshooting issues.
As the Contract and Credentialing Specialist:
- Responsible for compiling and maintaining current and accurate data for all providers
- Responsible for Data entry and maintaining provider information in online credentialing databases and systems (CAQH PECOS and NPPES)
- Responsible for Completing provider initial and re-credentialing applications
- Responsible for all Insurance contracting and re-credentialing submissions
- Audits applications for accuracy and completeness
- Responsible for maintaining an accurate and updated Contract Matrix
- Responsible for revalidation requests issued by government payers
- Responsible for Submitting completed credentialing application and supporting documentation to all requested payers
- Responsible for monitoring application progress and following up with payers as needed until confirmation of in network until status has been received
- Responsible for insurance contract reviews rate negotiations maintaining and communicating all contract responsibility rates and clauses that affect various departments including providers and Risk and Quality
- Manage EMR Contracts database
- Develop and modify dashboards and fields to meet business needs
- Will provide contract performance monitoring rate development and evaluation ad-hoc reporting and other analytical and operational support
- Responsible for maintaining fiscal summaries for provider entities that provide details on hospital (s) rates variances
- Stay abreast of renewals amendments and other contract changes
- Provide timely updates to the fiscal summaries to reflect these changes
- Manage rate changes throughout the year and communicate effectively with all provider entities
- Manage and maintain physician Inpatient and Outpatient reimbursement schedules in the systems contracts database
- Create and maintain reimbursement terms for Contract Codes
- Provide rate updates and support for all Contract Codes
- Updating and Maintaining State Contract schedule and accuracy
- Analysis of rate proposals
- Other duties as assigned
The Contract and Credentialing Specialist candidates will have the following:
- High School diploma or equivalent required
- Bachelors degree in healthcare or business administration preferred
- 3-5 years of experience working with Medicare/Pecos credentialing portal required
- Provider contract negotiation experience in healthcare field including but not limited to managed care and commercial payors required. Knowledge of Excel MS Project or other project management tools
- Familiar with provider credentialing and recredentialing requirements
- Strong analytic computer and software skills
- Excellent interpersonal skills including excellent verbal and written communication skills
- Ability to demonstrate a high degree of trust and confidentiality
- Ability to work independently and assume assigned responsibilities
- Skilled in efficiency organization time management and prioritization
- Ability to be flexible and function well in a fast-paced environment
- Ability to deal with problems involving several concrete variables in standardized situations
When you join the growing Vistas team as the Contract and Credentialing Specialist youll receive:
- Medical Dental and Vision
- 401(k) match
- Employer long term disability (LTD)
- Employer paid life and AD&D Insurance
- Generous Paid Time Off
- Flexible Spending Account
- Tuition Reimbursement
Vistas is an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race color religion age sex national origin disability status genetics protected veteran status sexual orientation gender identity or expression or any other characteristic protected by federal state or local laws.
Required Experience:
Unclear Seniority
Employment Type
Contract
