Manager Contracting & Credentialing

Description

Position Summary:  

The Contracting and Credentialing Manager reports to the CEO and oversees the process of contracting and credentialing to assure timely enrollment with payors. This is a hands-on position requiring the Contracting and Credentialing Manager to oversee staff and processes ensuring that accurate data needed for contracting and credentialing has been obtained and is current for all providers and for the practice. The Contracting and Credentialing Manager position requires professionalism, collaboration, and excellent decision making and communication skills. 

Duties and Responsibilities: 

• Define and implement processes to ensure contracting and credentialing is accurately completed in a timely manner 
• Negotiation and renegotiation of payor contracts 
• Implement seamless protocols for gathering and managing organizational licensure and provider licensure for onboarding, contracting, and credentialing where audit can occur readily to ensure the organization remains in compliance 
• Manage and update information regarding contracts and fee schedules 
• Complete market research including state licensure requirements, identification and development of payor lists, and determination of network participation and credentialing requirements 
• Work with revenue cycle management to ensure compliance guidelines are established and met 
• Grow and manage a team of contracting and credentialing assistants/coordinators 
• Manages special projects 
• Other Duties as assigned, this is a safety-sensitive position 

Qualifications: 

• Education: 
• Bachelor’s Degree Preferred. 
• Experience: 
• 3-5 years’ experience of medical contracting and credentialing experience preferred. 
• 2 years minimum supervisory experience required. 
• Skills: 
• Proficiency and experience with utilization of online portals including CAQH, 
• PECOS, and payor portals o Computer and software literacy including Google Suite and Microsoft Office suite o Excellent, efficient, and concise professional verbal and written communication skills o Ability to maintain professional demeanor and develop and maintain professional relationships 

Working Conditions: 

• May be exposed to/occasionally exposed to patient elements. o Subject to varying and unpredictable situations and interruptions. 
• Occasionally subjected to irregular hours. o Occasional pressure is due to a fast-paced environment. 
• Position may require lifting, carrying or pushing equipment or patients

Requirements

Physical Requirements: 

• May be exposed to/occasionally exposed to patient elements. 
• Subject to varying and unpredictable situations and interruptions. 
• Occasionally subjected to irregular hours.  
• Occasional pressure due to a fast-paced environment.  
• Position may require lifting, carrying or pushing equipment or patients.