The Credentialing & Contracting Specialists manages provider credentialing and works with the Revenue Cycle Manager (RCM) to negotiate payor contracts. The position also works closely with the Chief Medical Officer (CMO) and Quality Care Manager.
ESSENTIAL FUNCTIONS AND RESPONSIBILITIES
- Manage credentialing of providers and facilities with third party payors
- Work with CMO to maintain files for clinical staff and provider privileging
- Maintain documents for clinical staff / providers for HRSA reporting
- Run and evaluate patient insurance eligibility reports in the EMR
- Work with RCM manager to update rates with all payors
- Work with RCM manager in communicating with payers for contract renewals and negotiations
- Support the organization’s Mission, Vision, and Values.
- Perform all other appropriate duties as assigned based on skill set.
EDUCATION
- High School Diploma or equivalent
EXPERIENCE
- Prior medical office credentialing experience preferred
- Experience with managed care contracts and payer incentive programs helpful
Compensation details: 18-20 Hourly Wage
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