Contracting & Credentialing Support Specialst

3 weeks ago

Houston, United States Nexus Health Systems Ltd Full time
Job DescriptionJob Description

POSITION SUMMARY:

As a Contracting and Credentialing Specialist, reporting to the Director of Network Management, you will play a crucial role in ensuring the seamless integration of payor contracts, single case agreements, and the credentialing process within our organization. Your responsibilities will involve managing payer contracts, managing the credentialing process, and collaborating with various stakeholders to optimize reimbursement. Additionally, you will be involved in negotiating single-case agreements and working with out-of-state payors, demonstrating your ability to adapt to the evolving healthcare landscape.

JOB SPECIFIC RESPONSIBILITIES:

Payor Contracting

• Evaluate and negotiate contracts with payors, including single-case agreements, to maximize reimbursement rates and terms.

• Manage relationships with out-of-state payors, ensuring compliance with regional regulations and optimizing contractual terms.

• Collaborate with internal teams to align contractual agreements with organizational objectives.

• Stay informed about industry trends, regulations, and reimbursement methodologies.

Credentialing Management

• Oversee the credentialing process for healthcare providers, ensuring compliance with industry standards and regulations.

• Manage the credentialing process for providers involved in single-case agreements.

• Maintain up-to-date knowledge of credentialing requirements and work closely with providers to collect necessary documentation.

• Liaise with payors and accreditation bodies to facilitate the timely and accurate completion of credentialing processes.

Stakeholder Collaboration

• Establish and maintain effective communication with internal departments, including finance and operations, to ensure alignment with contracting and credentialing objectives.

• Collaborate with external stakeholders, such as payors and regulatory agencies, to address inquiries and resolve issues related to contracts and credentialing.

Data Management

• Maintain accurate and organized records of payor contracts, single case agreements, and credentialing documentation.

• Utilize tools to track and report on the status of contracts and credentialing processes.

Compliance and Quality Assurance

• Ensure adherence to regulatory requirements and industry standards in all contracting and credentialing activities.

• Conduct periodic audits to verify the accuracy and completeness of contract and credentialing documentation.

Additional Responsibilities

• Undertake any other responsibilities as assigned by the Director of Network Management to support the overall success of the department and organization.

POSITION QUALIFICATIONS:

EDUCATION:

• Bachelor’s degree in healthcare administration, business, or a related field.

EXPERIENCE:

• Previous experience in payor contracting, including single case agreements, and credentialing within the healthcare industry.

• Strong negotiation skills and attention to detail.

• Knowledge of healthcare regulations, reimbursement methodologies, and credentialing processes.

• Experience working with out-of-state payors.

• Excellent communication and interpersonal skills.

• Proficient in using relevant software and tools for data management.


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