Credentialing and Payor Contracting Specialist (Full-Time)
Payor Credentialing & Enrollment
Manage end-to-end credentialing and enrollment of organizational entities with Medicaid, MCOs, and commercial payors.
Credential and recredential physicians, advanced practice providers (APPs), and other clinical providers with all applicable payors.
Maintain credentialing timelines to avoid lapses in participation or reimbursement.
Serve as the primary point of contact with payors for credentialing-related inquiries, follow-ups, and issue resolution.
- Maintain accurate provider and entity data in credentialing systems, CAQH, and internal databases.
Hospital Medical Staff Privileging
Provide administrative support for hospital medical staff credentialing and privileging processes.
- Compile, submit, and track required documentation for initial and ongoing privileges.
- Monitor expiration dates and renewal cycles to ensure continuous compliance with hospital and regulatory requirements.
- Cook up communication between providers, hospitals, and internal stakeholders related to privileging status.
Payor Contract Financial Analysis
Aid with the financial review and analysis of payor contracts in coordination with the Director of Revenue Cycle and the VP of Government Relations.
- Support evaluation of reimbursement methodologies, rate structures, and contract terms.
- Help prepare summaries, comparisons, and impact analyses to inform contract negotiations and strategic decision-making.
- Maintain organized records of executed payor agreements and supporting financial documentation.
Contract Intake, Review & Dissemination
Serve as the central point person for coordinating the intake, tracking, and dissemination of all organizational contracts (payor and non-payor).
- Manage and enforce the contract checklist process for contracts entering or exiting the organization, ensuring appropriate review and approvals.
- Cook up communication with legal, finance, compliance, operations, and executive leadership to ensure contracts move efficiently through the review process.
- Maintain a centralized contract repository with accurate status tracking, key dates, and version control.
- Support contract renewals, amendments, and terminations by monitoring deadlines and notifying stakeholders.
Qualifications
- Bachelor’s degree in Accounting, Finance, Economics, or Healthcare Administration with a strong accounting or financial analysis foundation.
- 2+ years of experience in a financial analyst, contracting analyst, revenue cycle, or healthcare finance–adjacent role with demonstrable analytical responsibility.
- Experience in public accounting, internal audit, FP&A, revenue integrity, or healthcare finance.
- Ability to understand and communicate effectively and professionally in reading, writing, and speaking the English language.
Benefits
- Medical, dental, and vision insurance
- Health Savings Account (HSA) and Flexible Spending Account (FSA) options
- Employee Assistance Program (EAP)
- 403(b) retirement plan with company match
- Life and disability insurance
- Paid Time Off (PTO)