Payor Contracting and 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 provides technology-enabled healthcare management solutions that connect the patient journey from referral through reimbursement. We help healthcare organizations improve operational efficiency, strengthen revenue performance, and give providers more time to focus on patient care.

About the Role

Employment Type: Full-time

Work Arrangement: In person

Location: Fresno, California

About nCare

nCare provides technology-enabled healthcare management solutions that connect the patient journey from referral through reimbursement. We help healthcare organizations improve operational efficiency, strengthen revenue performance, and give providers more time to focus on patient care.

The Payor Contracting and Credentialing Specialist is responsible for managing health plan contracting, provider credentialing, and enrollment activities for nCare and its healthcare practice partners. This position develops relationships with public and private payors, supports contract and rate negotiations, maintains contract records, and ensures providers are properly credentialed and enrolled.

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

Payor Contracting

• 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.
• Analyze proposed reimbursement rates against existing agreements, Medicare benchmarks, and organizational objectives.
• Maintain an organized repository of contracts, amendments, fee schedules, correspondence, and related documents.
• Track contract status, effective dates, renewals, expirations, rate changes, and outstanding requirements.
• Communicate executed contract terms and operational requirements to credentialing, billing, revenue-cycle, implementation, and client teams.
• Coordinate single-case agreements and other nonstandard payor arrangements when needed.
• Confirm that contracted rates and provider participation statuses are accurately loaded in payor systems.

Credentialing and Enrollment

• Manage initial credentialing, recredentialing, and enrollment for individual providers, groups, and facilities.
• Complete and monitor applications through CAQH ProView, PECOS, NPPES, state Medicaid systems, and commercial payor portals.
• Maintain current provider records, including professional licenses, DEA registrations, board certifications, malpractice coverage, education, employment history, and attestations.
• Submit provider rosters, demographic changes, location additions, tax-identification updates, EFT and ERA enrollments, and terminations.
• Monitor expiring credentials and coordinate renewals before established deadlines.
• Follow up with payors to resolve incomplete applications, discrepancies, returned submissions, and enrollment delays.
• Verify effective dates and network participation before services are billed as in network.
• Maintain accurate status notes, supporting documents, and audit trails within nCare’s systems.
• Assist providers and practice administrators with credentialing questions and document requests.
• Support internal and external credentialing audits.

Revenue-Cycle and Operational Support

• Partner with billing and accounts-receivable teams to resolve claim issues related to credentialing, enrollment, contracting, and payor configuration.
• Research network-participation disputes, incorrect reimbursement, enrollment-related denials, and payor-directory inaccuracies.
• Verify that contracted rates and payor requirements are reflected correctly in billing workflows.
• Identify recurring payor issues and recommend process improvements.
• Maintain standard operating procedures, status reports, trackers, and escalation workflows.
• Protect confidential provider, practice, and patient information in accordance with HIPAA and company policies.
• Perform other related duties and projects as assigned.

Qualifications

• Bachelor's degree in healthcare administration, business administration, finance, or a related field preferred.
• Three to five years of experience in payor contracting, managed care, provider enrollment, credentialing, or healthcare practice operations preferred.
• Prior provider credentialing and payor-enrollment experience required.
• Working knowledge of CAQH ProView, PECOS, NPPES, Medicare, Medicaid, and commercial payor processes.
• Experience reviewing payor contracts, fee schedules, reimbursement terms, and participation requirements.
• Understanding of healthcare billing, claims, denials, prior authorization, and revenue-cycle workflows.
• Strong organizational skills and the ability to manage multiple applications, deadlines, and follow-up activities.
• Excellent written and verbal communication skills.
• Strong analytical, negotiation, documentation, and problem-solving abilities.
• High level of accuracy, accountability, discretion, and attention to detail.
• Proficiency with Microsoft Excel, payor portals, document-management systems, and workflow-tracking tools.
• Ability to work collaboratively in a full-time, in-person office environment.

Preferred Qualifications