Contracting and Credentialing Specialist

2 weeks ago


Idaho Falls, Idaho, United States BRAD HALL COMPANIES Full time
Job Details

Job Location
J4K Coronado - Idaho Falls, ID

Travel Percentage
Negligible

Job Category
Admin - Clerical

Description

Just 4 Kids Health is seeking a skilled Contracting and Credentialing Specialist to maintain physician privileging and provider credentialing. The ideal candidate will have a deep understanding of negotiating in-network contracts with insurance carriers and be familiar with agency standards and requirements for credentialing licensed providers. This role requires collaboration with staff to ensure a unified approach to delivering high-quality service.

Key Responsibilities
  • Credential all providers in the practice, including Medicaid application and Managed Care credentialing for all providers.
  • Credential facilities with insurance carriers.
  • Negotiate in-network contracts with insurance carriers for physicians and facilities.
  • Maintain contracts.
  • Apply for and maintain hospital privileges for providers in the practice as needed, and work closely with hospital credentialing department.
  • Meet with providers to gather, review, and provide guidance on completion of credentialing packets.
  • Coordinate the input of physician information into CAQH and Medicaid and database.
  • Oversee input of physician documents into database and proper maintenance of Medicaid documents.
  • Continuously verify the status of provider licenses, DEA, CSR certificates, and specialty certificates.
  • Ensure provider information is forwarded to the appropriate channels on a routine basis.
  • Maintain provider files for credentialing purposes.
  • Regularly update physician relevant information and send to all payers.
  • Contact appropriate organizations upon hiring of new providers.
  • Act as backup for medical biller for both J4K Urgent Care and Primary Care.
  • Conduct Medicaid reviews.
  • Negotiate reimbursement rates.
  • Identify and resolve denials of high-dollar medical claims.

Qualifications
  • Minimum High School Diploma/G.E.D.
  • 3+ years of experience with physician and facility credentialing is required.
  • Minimum 3+ years of experience with negotiating in-network contracts directly with insurance carriers for physician and facilities required.


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