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Bancroft · 15 hours ago

Contracts & Credentialing Paralegal

Cherry Hill, NJ

Full-time

Onsite

Mid Level

$69K/yr - $81K/yr

3+ years exp

Bancroft is an organization dedicated to helping people with disabilities achieve fulfilling lives. They are seeking an experienced Contracts & Credentialing Paralegal to manage payer relationships, oversee credentialing operations, and ensure compliance with regulatory standards.

CommunitiesHealth CareNon ProfitSocial

Responsibilities

Prepares documentation for all payor applications and contracts, including, but not limited to commercial payor initial and re-credentialing applications, annual government contract renewals (both State and Federal), Medicaid applications and revalidations, MLTSS, other State payors, including, but not limited to, NJ DDD, NJ DHS, NJ CSOC, PA DDD, PA DHS, PA Medicaid, DE DDD, IL DDD, school districts, private pay

Maintains file of required reference documents and obtains updated versions from source departments as needed; protects confidentiality of same

Maintains inventory of all contracts and fee agreements; updates and manages payor contracts in Contract Lifecycle Management (“CLM”) database in Workday

Prepares/maintains/updates contract summaries

Maintains contracting calendar, scheduling renewals, re-contracting, etc

Prepares contract summaries with key terms, etc., for presentation to and review by senior leadership for use for new and renewal contracts

Maintains record of all organizational Medicaid provider numbers and NPI numbers

Prepares and revalidates new group home applications, including NPI numbers

Reports diversity data quarterly or more frequently, if required, to payors and governmental entities

Leads organizational and individual provider credentialing to ensure participation, including, but not limited to Medicare, Medicaid, managed care insurance providers

Establish CAQH accounts for onboarding clinical providers and complete all CAQH applications

Maintain database of all credentialed providers with relevant, supporting documentation

Research and resolve any credentialing issues; manage deactivation of provider numbers

Maintain and verify demographic information

Leads the process for practitioner applications, including accompanying documents, to ensure applicant eligibility

Processes requests for privileges, ensuring compliance

Prepares credential files for presentation to Clinical Executive Group

Monitors the initial, reappointment and expiration process for all employed clinical providers, ensuring compliance with regulatory bodies

Qualification

Payer contractingCredentialing operationsRegulatory complianceContract Lifecycle ManagementMicrosoft OfficeEffective communicationInterpersonal skillsIndependent work

Required

Bachelor's degree preferred

at least 3+ years of experience, with a preference to individuals with experience directly related to a hospital, physician group, managed care or outpatient practice credentialing

Demonstrated ability to effectively communicate both written and verbally required

Ability to think and work independently, meet deadlines and ensure that assigned projects are completed in a timely and efficient manner

Effective interpersonal skills

Working knowledge of Microsoft Office suite

Valid driver's license required in incumbent's name

Preferred

Preference will be given to National Association Medical Staff Services (NAMSS) certification as a Certified Medical Services Manager (CPMSMS) or Certified Provider Credentials Specialist (CPCS)