Credentialing & Contract Management Specialist

This role supports an in-person position at our Syracuse office, full-time Monday through Friday, 8:00 AM – 4:30 PM.

About the role

Nascentia Health is seeking a highly organized and detail-oriented Credentialing and Contract Management Specialist to join our Provider Relations team. This role will organize, maintain, and verify all aspects of the credentialing process, track expirations of certificates and licenses, and assist health plan providers with inquiries. The individual will join a fast-paced, innovative team passionate about developing and managing processes and analyses to improve healthcare decisions.

Responsibilities

• Review credentialing files and work with healthcare providers to obtain missing, incomplete, or expiring items to ensure accuracy and consistency.
• Establish and maintain long-term working relationships with healthcare providers to ensure customer satisfaction and retention.
• Maintain consistent contact with healthcare providers to clarify expectations and ensure timely completion of requirements.
• Utilize advanced problem-solving skills to resolve issues and conflicts that may arise.
• Use credentialing software to complete initial credentialing, re-credentialing, and process documentation.
• Collect and verify data, and communicate with personnel.
• Process credentialing applications to add providers to commercial payors, Medicare, and Medicaid.
• Ensure accurate data collection and verification of information critical to the credentialing process.
• Serve as the point of contact regarding the status of applications for all credentialed providers.
• Provide subject matter expertise to staff regarding credentialing issues.
• Maintain a database to support credentialing functions and manage information effectively.
• Screen provider applications and supporting documentation to ascertain eligibility.
• Collect information from the National Practitioner Data Bank (NPDB), applicants, and their malpractice insurers and other relevant sources.
• Coordinate and maintain CAQH and NPPES credentialing for all providers.
• Capture primary source documentation in the computer database.
• Ensure compliance with applicable laws, regulations, procedures, and policies.
• Assist in developing processes to drive efficiency across multiple corporate and operational teams.
• Coordinate provider relations processes, including communication content development, Continuing Medical Education, contractual questions, and administrative policy and procedure.
• Update and maintain the provider directory.
• Routinely audit the Provider Directory in accordance with established guidelines and timelines.
• Ensure documentation is prepared in time for committee packet mailing deadlines.
• Consistently perform to department accuracy and quality audit standards while maintaining timeliness measures.
• Communicate with providers regarding the status of contract approval or denial.
• Track and report on delegated providers and obtain required documentation per Credentialing Guidelines.
• Perform general office duties, including answering phones, processing contracts, filing, and mass mailings.

Requirements

• Bachelor’s degree or Associate’s degree with a minimum of 2 years of relevant experience.
• Credentialing experience is a plus.
• Knowledge of Medicare and Medicaid preferred.
• Ability to work independently, manage multiple assignments, and prioritize workload.
• Strong communication skills, both in-person and over the phone.
• Proficiency in Microsoft Office.
• Ability to learn the organization’s software system to perform job duties.

Physical Requirements

• Speech, visual, and hearing ability sufficient to express and comprehend written and verbal communication.
• Ability to sit or stand 90% of the day.
• Frequent sitting, standing, walking, pushing, pulling, reaching, and kneeling.
• Bloodborne Pathogens Exposure Category III – Employee who rarely has contact with blood and body fluids.

Pay

$19.96–$24.96/hour (non-exempt position).

Benefits

• Retention bonuses
• Internal mentoring program
• 401K with generous employer match
• On-site gym (free for all employees)
• Potential hybrid position (partial work from home)
• Medical, dental, and vision plans
• Tuition reimbursement
• Partially funded HSA
• Employee recognition platform
• Paid time off, holidays, sick leave, and extended sick leave
• Short-term and long-term disability
• Employee Assistance Program (EAP)

About Nascentia Health

Nascentia Health is leading the way in home care, post-acute care, and long-term community health. As a healthcare system without walls, Nascentia is an innovator in patient-centered care, addressing immediate needs while supporting long-term medical and lifestyle choices for better outcomes. Our employees are dedicated to our mission of being the premier home and community-based care system for the regions we serve.