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NEOGOV · 4 months ago

Contracting & Credentialing Specialist

Tucson, AZ

Full-time

Onsite

Mid, Senior Level

$70K/yr - $70K/yr

3+ years exp

NEOGOV is seeking a Contracting & Credentialing Specialist responsible for negotiating and managing payer contracts while overseeing the credentialing of healthcare providers. This role ensures compliance with regulatory requirements and aligns payer agreements with the organization's goals.

GovTechHuman ResourcesInformation TechnologySoftware

Responsibilities

Negotiate and manage contracts with commercial insurers, Medicare, Medicaid, and other third-party payers

Analyze reimbursement rates and contract terms to ensure financial sustainability

Monitor contract performance, including payment accuracy and payer compliance

Collaborate with internal stakeholders, including finance, legal, and revenue cycle teams, to optimize contract terms

Maintain a database of contracts, expiration dates, and amendments, ensuring timely renewals and updates

Maintain strong relationships with payer representatives and resolve contract-related issues

Process initial credentialing and re-credentialing applications for providers, ensuring compliance with regulatory requirements

Collect, verify, and maintain provider credentials, including licensure, certifications, education, and work history

Monitor upcoming expirations for licenses, certifications, and payer enrollments to ensure uninterrupted provider participation

Conduct background checks, malpractice history reviews, and sanction screenings

Coordinate with national and state credentialing bodies, such as CMS, NCQA, and others to ensure timely approval

Maintain provider data in credentialing software and update records as needed

Submit and follow up on provider enrollment applications with payers to ensure timely approvals

Ensure compliance with healthcare regulations, including, but not limited to HIPAA, NCQA, and CMS guidelines

Stay up to date with changes in credentialing and contracting regulations to ensure the organization remains compliant

Assist in audits and reporting related to provider credentialing and contracting

Serve as the main point of contact for providers regarding credentialing and contracting inquiries

Work collaboratively with internal departments, including HR, billing, and compliance teams, to ensure provider credentialing is completed efficiently

Provide education and support to providers regarding credentialing requirements and processes

Qualification

Healthcare regulationsCredentialing softwareContract negotiationPayer relationsProvider enrollmentAnalytical skillsPublic speakingInterpersonal skillsLeadershipCustomer focus