Credentialing and Contract Specialist

Nrg-Mgmt-LLC; Town of Florida (NY); On-site; USD 46,000 - 50,000; Full time

Benefits offered by this job

401(k)

401(k) matching

Dental insurance

Health insurance

Life insurance

Paid time off

Tuition reimbursement

Vision insurance

Job summary

NRG Management is seeking a full-time remote Credentialing and Contract Specialist in Boca Raton, FL area. The role handles credentialing, re-credentialing, and privileging for medical staff in mental health and addiction services, enrolling providers with payers and maintaining licensure and credentialing documentation.

Experience in credentialing and provider enrollment is required. Preferred CPCS certification; degree in Healthcare Administration or equivalent experience; 2 years

Qualifications

• Healthcare Administration degree preferred or meets experience requirements.

Responsibilities

• Perform all aspects of credentialing, re-credentialing, and privileging for applicable medical staff.
• Maintain CAQH, PECOS, and NPI registry for IHTC providers.
• Maintain copies of state licenses, CSR and DEA certificates, malpractice coverage, and other credentialing documents.
• Track license and certification expirations to ensure timely renewals.
• Coordinate with Billing Manager to attach providers to contracts.
• Update provider demographics with payers as needed.
• Audit health plan directories for current provider information.
• Develop and implement new contracts.
• Support development of new business, acquisitions, and facility expansion.
• Influence contract strategy in negotiations with third-party payers.
• Lead discussions with payers on rates and language under guidelines.
• Maintain positive relationships with payer networks.
• Communicate contract requirements/changes internally after execution.
• Review solicitations and prepare routine responses for proposals and amendments.

Education

Healthcare Administration degree

Job description

Job Details

Job Location: REMEDIAL PRO - Boca Raton, FL 33463

Position Type: Full Time

Salary Range: $22.00 - $24.00

Job Shift: Day

Job Category: Admin - Clerical

Job Type: Full-time

Expected hours: 40 per week

Work Location: Remote

Job Summary

NRG Management is looking for a full-time remote Credentialing and Contract Specialist. The Credentialing and Contract Specialist may be familiar with Credentialing Providers In and out of network for Residential Detox, Partial Hospitalization and Intensive Out-Patient care in the Co-Occurring and Substance Abuse field. As a Credentialing and Contract Specialist, you will be responsible for credentialing, re-credentialing and privileging of all applicable medical staff. Also responsible for enrolling providers in all applicable public and private payer organizations. Experience in the Mental Health/Addiction space preferred.

The Opportunity

• Perform all aspects of the credentialing, re-credentialing, and privileging process of applicable medical staff
• Maintain CAQH, PECOS, and NPI registry for all IHTC providers as applicable.
• Maintain copies of current state licenses, CSR and DEA certificates, malpractice coverage, and other required credentialing documents.
• Track license and certification expirations for all providers to ensure timely renewals.
• Coordinate with the Billing Manager to ensure all applicable providers are correctly attached to all existing and new contracts.
• Could you make sure provider demographics are kept updated with all payers?
• Audit health plan directories for current and accurate provider information.
• Manage the development and implementation of new contracts
• Participate in the development of new business, acquisitions, and facility expansion.
• Influence contract strategy in complex contract negotiations and discussions.
• Lead contract discussions with third-party payers, including rate and language negotiation under established guidelines.
• Establish and maintain positive working relationships with third-party payer networks.
• Coordinates the implementation of executed contracts to properly communicate contract requirements/changes internally.
• Review solicitations and prepare routine responses for proposals, bids, and contract modifications, as necessary.

Benefits

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Tuition reimbursement
• Vision insurance

Schedule

Monday to Friday

People with a criminal record are encouraged to apply

Education

Healthcare Administration degree preferred or meets experience requirements.

Experience

• Provider Credentialing: 2 years (Required)
• Onboarding Provider: 1 year (Required)

License/Certification

• Certified Provider Credentialing Specialist (CPCS) (Preferred)

Qualifications

• Degree in Healthcare Administration or equivalent experience preferred
• 3 years of job-related work experience may be accepted in lieu of degree
• Four years of experience with healthcare provider enrollment and/or credentialing