Credentialing and Contracts Specialist
AccentCare® is a national post-acute healthcare provider with 45 years of industry experience. We thrive on providing patient-centric care and a warm and personalized experience within our local communities.
Your Success is our Success. We strive to provide our new employees with a structured on-boarding process to help you become assimilated quickly, and cutting-edge tools to make your daily work easier and more efficient. We offer extensive training and a wide-array of opportunities for continued education and promotional opportunities.
Position: Credentialing Specialist
Reports to: Director of Contracts/Payer Relations
*Position requires CV-19 Vaccination as a condition of employment.
Responsible for credentialing functions of gathering, validating and submitting payer credentialing applications to support contract management. These functions include initial data points and ongoing updates related to payer demographics, contract terms, credentialing of all managed care payer contracts.
- Prepares and maintains Contract Applications, when necessary.
- Maintains contract provider information in contract database (STARS).
- Communicates service rates to AR, along with billing requirement information as outlined in payor contracts, as directed by Supervisor.
- Coordinates with AR Department regarding provider contract and credentialing updates to ensure organization TIN and NPI information is registered correctly with payors. as directed by Supervisor.
- Supports Credentialing Supervisor with contract matters regarding credentialing.
- Work with key departments/branches in gathering, entry, validation, maintenance, and management of the data points listed above as well as any additional data related to the administration of payer contracts.
- Serve as a subject matter expert to the field regarding credentialing matters, data, and Ensures accuracy and completeness of all pertinent CM resource data.
- Assists in maintaining the department’s computerized tracking system to ensure completeness of credentialing documentation, and contract files to support Contract Management readiness for day-to-day processes, including special projects.
- Update monthly reports related to contract implementation and administration, as needed
- Performs other related activities by Contract Department growth and change.
Requirements of Qualified Candidates:
- Associate degree or equivalent work experience (2-5 years)
- 2-5 years of managed care payer/ provider experience in network contracting administration, provider relations or other administrative functions in an operational capacity
- Demonstrated experience in an administrative/support-type role
- Working knowledge of ancillary services managed care contracts and data
- Must have solid computer skills and proficiency in various applications
Skills and Abilities:
- Problem-solving & task analysis skills
- Ability to work in a fast-paced, multi-task environment with competing priorities
- Self-motivated and a strong team player
- Proven administrative skills; must be detail oriented.
- Strong communication and organizational skills
- Ability to manage multiple deliverables related to data management with the ability to identify issues, problem-solve and escalate problems as they arise