Credentialing Administrator - Hybrid - Elkin, NC

Responsibilities

• Coordinate and manage the full lifecycle of provider credentialing and recredentialing, including primary source verification of education, training, licensure, certifications, malpractice coverage, and work history.
• Maintain accurate credentialing records and databases, monitor expiration dates for licenses and certifications, and initiate renewals to ensure ongoing compliance with regulatory and accreditation standards such as those established by The Joint Commission and National Committee for Quality Assurance.
• Prepare credentialing and recredentialing files for review and approval while ensuring all documentation meets organizational and regulatory requirements.
• Review and track more than 550 provider contracts during the recredentialing cycle, ensuring alignment with organizational policies, payer requirements, and contract terms.
• Collaborate with legal, compliance, payer relations, and internal departments to resolve discrepancies, maintain documentation, and support audits or compliance reviews.
• Serve as a primary point of contact for providers and internal stakeholders regarding credentialing documentation, contract updates, and status reporting.
• Administers and organizes communication to management regarding industry trends and payer updates to determine the overall impact of these changes to the organization.
• Prepares and delivers monthly/quarterly target reports to departments that are involved with or impacted by payer contracts to include target plans, contract acquisitions, contract denials and formulary plans.
• Prepares and delivers monthly/quarterly target reports to departments that are involved with or impacted by payer contracts to include target plans, contract acquisitions, contract denials and formulary plans.
• High level proficiencies of all facets within Payer Relations including, but not limited to credentialing, contracting, EDI, Zoho CRM, internal and external payer databases, communications, and administrative maintenance responsibilities.
• Pursues continual high-level understanding and execution regarding Medicare and non-Medicare payers, Medicaid and Managed Care Organizations, and Workers’ Compensation plans as it pertains to regulatory standards and compliance, as well as a keen understanding of industry-related competition and current market.

Qualifications

• A Highschool Diploma or equivalent, associate or bachelor’s degree in business or other healthcare related field and 1-3 years of healthcare experience, preferred or any similar combination of education and experience.
• General knowledge of medical business organization and operations.
• General knowledge of government and commercial insurance regulations.
• General computer and internet navigation skills.
• Proficiency in Microsoft applications (Word, Excel, PowerPoint and Outlook).
• Effective verbal and written communication skills.
• Attention to detail in composing, typing, and proofing materials, establishing priorities and meeting deadlines.
• Demonstrated ability to juggle multiple competing tasks and demands.
• Ability to professionally interact and communicate with individuals at all levels of the organization.

Benefits

• Health, Dental, Vision, Life, Disability
• 401K
• Company Paid Holidays
• Paid Time Off
• Education Assistance Program
• Community Involvement
• Employee Engagement Opportunities