Healthcare Payer Relations Credentialing and Contract Support Specialist

About the role

This position is responsible for prioritizing and cataloguing all incoming payer credentialing requests to ensure timely and efficient turnaround. It also involves maintaining new and existing payer credentialing data in related computer systems, assisting the Payer Relations Contract Manager(s) with additional duties as needed, and managing the new and existing payer credentialing process.

Responsibilities

• Logs incoming payer credentialing requests and payer contract requests in corresponding computer system and presents contracts to Payer Relations Contract Manager(s) for follow through.
• Serves as primary contact for all internal and external payer credentialing inquiries.
• Manages new and existing payer credentialing process to verify that deadlines are met.
• Gathers and maintains all credentialing documentation and obtains missing or incomplete information to accurately meet external credentialing requests.
• Updates existing payer credentialing documentation and applications.
• Handles inquiries that are escalated to the department as it pertains to credentialing and network status.
• Establishes working relationships and collaborates with external organizations as it pertains to payer credentialing and network status.
• Responsible for working with key internal stakeholders to ensure commutation of key objectives and responsibilities.
• Manage, maintain and organize the contracting and credentialing database while creating and implementing alerts based on contractual agreement provisions as it pertains to payer credentialing and payer network status.
• Identifies and recommends credentialing process and workflow improvements.
• Afford assistance with providing information for internal and external audits.
• Processes administrative tasks as needed and requested by management.

Requirements

• Knowledgeable in credentialing processes and procedures for paying/payer entities.
• Demonstrate excellent verbal and written communication skills and have the ability to communicate tactfully with department heads, managers, coworkers and vendors to resolve problems and negotiate resolutions.
• Be familiar with general claims, authorization and contracting processes of health care organizations.
• Be comfortable interacting with internal and external entities, particularly health plans.
• Maintain good working relationship with key contacts.
• Ability to work independently, prioritize and meet deadlines.
• Adhere to company policies and procedures.
• Maintain attention to detail and possess excellent data entry skills.
• Working knowledge of computers, internet access, and have the ability to navigate within an automated system as well as a variety of software packages including but not limited as to Microsoft Windows.

Qualifications

• Associates degree in Business, Healthcare or related field preferred.

Special Instructions to Candidates

EEO/AA M/F/D/V