The Contract & Credentialing Specialist is held responsible for managing the credentialing, re-credentialing, licensing, and contracting administration processes for providers and organizations, ensuring compliance with legal and regulatory requirements. This includes verifying qualifications, timely submissions and maintaining accurate provider information.

Principal Duties and Responsibilities

•    Manage credentialing, re-credentialing and payer attestations
•    Ensure adherence to all applicable state, federal and regulatory requirements for credentialing and contracting
•    Manage all wholesale contracts
•    Manage and maintain payer portal access for Provider Relations and RCM 
•    Support Medicaid enrollments
•    Support & maintain all accreditation required documentation for renewals and compliance
•    Ensure up-to-date business licenses required per state
•    Manage RCM & Provider Relations expenses and accruals
•    Maintain accurate and up-to-date provider information in databases, ensuring timely updates and reporting
•    Support RCM by managing and maintaining EFT portal access and payer enrollment for claims submissions 
•    Have a comprehensive understanding of the coding, coverage and payment components of assigned product lines
•    Maintain & update payer database with current fee schedules including government, workers’ compensation, auto and commercial
•    Support Provider Relations regarding new contractual agreements with government and private payers in the health insurance and workers’ compensation areas to open new sources of business for products