Nira Medical ยท 1 month ago
Credentialing and Contracting Coordinator
United States
Full-time
Remote
Mid, Senior Level
4+ years expNira Medical is a national partnership of physician-led, patient-centered independent practices focused on advancing neurological care. The Credentialing & Contracting Coordinator will ensure that providers are fully credentialed and contracted, manage provider enrollment, and collaborate with various teams to support the organization's revenue cycle needs.
Health CareHospitalMedical
Responsibilities
Ensure all providers are fully credentialed and enrolled in accordance with state, federal, and payer-specific regulations
Maintain an accurate credentialing database, tracking expirations and renewals, and managing complete enrollment workflows with Medicare, Medicaid, and commercial payers
Oversee CAQH maintenance, NPI and PECOS updates, and payer portal applications while monitoring enrollment timelines and following up with payers to prevent delays
Support the management and optimization of payer contracts by monitoring renewal timelines, ensuring appropriate reimbursement rates, and assisting in contract analysis
Help verify rate accuracy, process contract load requests, and evaluate payer participation needs for new locations, acquisitions, and service expansions
Ensure compliance with all payer credentialing requirements and regulatory standards while maintaining clean, audit-ready credentialing files
Prepare reports for leadership, support internal and external audits, and keep a centralized tracking system with real-time updates on application status
Serve as a key liaison between providers, payers, and internal revenue cycle teams, facilitating timely issue resolution and clear communication
Provide education to providers regarding reimbursement structures, contract terms, and credentialing expectations
Partner closely with RCM teams to ensure provider enrollment and credentialing processes do not disrupt cash flow or claim submission readiness
Identify and resolve credentialing-related payment issues, support onboarding for new providers and practice locations, coordinate payer setup requirements with IT and EMR teams, and escalate enrollment risks when needed
Manage all facility-level and operational changes that must be communicated to payers, including address updates, NPI/TIN linkages, Pay-To and Billing address changes, and the addition of new locations to existing contracts
Qualification
Required
Associate's/bachelor's degree in healthcare administration, business, or a related field; or equivalent relevant experience in credentialing, payer contracting, or healthcare operations
Minimum 4+ years of experience in provider credentialing, payer enrollment, or payer contracting
Strong knowledge of payer credentialing requirements, fee schedules, and contract structures
Minimum 3+ years of experience in revenue cycle management, healthcare regulations and/or compliance standards
Proactive, self-motivated, and adaptable to the evolving needs of a growing organization
Strong problem-solving skills and ability to work independently
Excellent relationship management and negotiation skills
Ability to collaborate in a data-driven, customer focused team environment
Preferred
Experience working in a startup, scaling healthcare organization, fast-paced RCM environments, with multi-specialty practices or MSO structures preferred
Certified Provider Credentialing Specialist (CPCS) certification, and Athena EHR experience is a plus
Experience with multi-specialty practices or MSO structures preferred
Company
Nira Medical
Nira Medical is a healthcare company focused on advancing outpatient neurological care.
51-200 employees
Funding
Current Stage
Growth StageCompany data provided by crunchbase