Credentialing & Contract Management Specialist

Credentialing & Contract Management Specialist

his role supports an individual to work in person at our Syracuse office!

Nascentia Health is looking for a highly organized and detail-oriented Credentialing and Contract Management Specialist to join our Provider Relations team. This role will be responsible for organizing, maintaining, and verifying all aspects of the credentialing process. They will also be responsible for tracking expirations of certificates/licenses to maintain up-to-date files and assisting health plan providers with inquiries. The individual will be joining a fast-paced and innovative team passionate about developing and managing processes and analyses to help make better, more informed healthcare decisions.

Performance Responsibilities and Standards:

• Review credentialing files and work with healthcare providers to obtain missing, incomplete, and expiring items and ensure accuracy and consistency, etc.
• Establish and maintain long-term working relationships with healthcare providers to ensure customer satisfaction and retention.
• Maintain consistent contact with healthcare providers to ensure that expectations are clear, and requirements are completed in a timely manner.
• Utilize advanced problem-solving skills to resolve issues and conflicts that may arise.
• Use credentialing software to complete initial credentialing, re-credentialing, and processing documentation.
• Collect and verify data and communicate with personnel.
• Process credentialing applications to add providers to commercial payors, Medicare, and Medicaid.
• Assure accurate data collection and verification of information critical to the credentialing process.
• Serve as point of contact regarding the status of applications for all credentialed providers.
• Provide subject matter expertise to all staff, as needed, regarding credentialing issues.
• Maintain database in support of credentialing functions to manage information effectively and efficiently.
• Screen provider’s applications and supporting documentation to ascertain their eligibility.
• Collect information from National Practitioner Data Bank (NPDB), applicant, and their malpractice insurer and other relevant sources.
• Coordinate and maintain CAQH and NPPES credentialing for all providers.
• Capture primary source documentation in the computer database.
• Ensure compliance with applicable laws, regulations, procedures, and policies.
• Assist in developing processes to drive efficiency across multiple corporate and operational teams.
• Coordinate provider relations processes including communication content development, Continuing Medical Education, contractual questions, and administrative policy and procedure.
• Responsible for updating and maintenance of the provider directory.
• Routinely audit Provider Directory in accordance with established guidelines within established timelines.
• Ensure documentation is prepared in time for committee packet mailing deadline.
• Consistently perform to department accuracy and quality audit standards results while maintaining timeliness measures.
• Responsible for communication with providers for status of contract approval or denial.
• Responsible for tracking and reporting on delegated providers and obtaining required documentation per the Credentialing Guidelines.
• Responsible for general office duties, answering the phone, processing contracts, filing, and mass mailings, etc.

Requirements:

• Bachelor’s degree or Associates degree with a minimum of 2 years of relevant experience.
• Knowledge of Medicare and Medicaid preferred.
• Ability to work independently, manage multiple assignments, and prioritize workload.
• Strong communication skills person-to-person and over the phone.
• Knowledge and skill in use of Microsoft office.
• Ability to learn organization’s software system to perform job duties.

Physical Requirements:

• Speech, visual and hearing ability sufficient to express and comprehend written and verbal communication
• Ability to sit or stand 90% of the day
• Frequent sitting, standing, walking
• Pushing, pulling, reaching, kneeling
• Bloodborne Pathogens Exposure Category III – Employee who rarely has contact with blood and body fluids.

Competitive Salary [This position is an H06 non-exempt…