Fresno Payor Contracting & Credentialing Specialist

nCare MD; Fresno (CA); On-site; USD 60,000 - 90,000; Full time

Job summary

nCare, Fresno, CA, is seeking a Payor Contracting, Credentialing, and Enrollment Specialist to support health plan contracting, provider credentialing, and enrollment for our practice partners. This role is in-person and requires coordination with billing, compliance, and operations teams.

The ideal candidate has hands-on credentialing experience, understands reimbursement and managed-care contracting, and can manage multiple deadlines with accuracy and professionalism.

Qualifications

• Bachelor's degree preferred in healthcare administration, business, finance, or related field.
• 3–5 years of experience in payor contracting, managed care, provider enrollment, credentialing, or healthcare practice operations preferred.
• Prior provider credentialing and payor-enrollment experience required.
• Familiarity with CAQH ProView, PECOS, NPPES, Medicare/Medicaid, and commercial payor processes.
• Experience reviewing payor contracts, fee schedules, and reimbursement terms.
• Understanding of healthcare billing, claims, denials, and revenue-cycle workflows.
• Strong organizational skills and ability to manage multiple applications and deadlines.
• Excellent written and verbal communication skills.
• Proficiency with Excel and payor portals.

Responsibilities

• Identify contracting opportunities based on each practice’s specialty, location, patient population, and growth objectives.
• Develop and maintain relationships with commercial insurance companies, Medicare Advantage plans, Medicaid programs, and other payors.
• Prepare and submit letters of interest, participation applications, contracting requests, and supporting documentation.
• Coordinate contract and reimbursement negotiations with nCare leadership and client stakeholders.
• Review payor contracts, fee schedules, reimbursement methodologies, amendments, renewal terms, authorization requirements, and termination provisions.
• Monitor expiring credentials and coordinate renewals before deadlines.
• Submit provider rosters, demographic changes, location additions, tax-identification updates, EFT enrollments, and terminations.
• Follow up with payors to resolve incomplete applications and enrollment delays.
• Verify effective dates and network participation before services are billed as in-network.

Skills

Organizational skills

Communication skills

Analytical thinking

Negotiation

Education

Bachelor's degree in healthcare administration, business administration, finance, or related field

Tools

Microsoft Excel

Payor portals

Document-management systems

Workflow-tracking tools

Job description

nCare, Fresno, CA, is seeking a Payor Contracting, Credentialing, and Enrollment Specialist to support health plan contracting, provider credentialing, and enrollment for our practice partners. This role is in-person and requires coordination with billing, compliance, and operations teams.

The ideal candidate has hands-on credentialing experience, understands reimbursement and managed-care contracting, and can manage multiple deadlines with accuracy and professionalism.