Credentialing and Contracting Specialist (Experienced!)

Description

Job Summary:

The Credentialing and Contracting Specialist will be responsible of our Provider Networks through contracted primary care physicians and specialists, key hospitals, ancillary and any other necessary providers to support LA CENTA?s goals including a healthy population, while achieving high quality measures.

Job Duties And Responsibilities
? Develop, negotiate and maintain provider contracted networks and execute contracts that support network needs.
? Handle contracting and credentialing needs when provider joins or leaves group
? Develop and maintain strong, cost effective and mutually supportive relationships with key providers and clients.
? Maintain internal contract database for management of accurate data and complete contract detail. Ensure timely re-credentialing, when needed.
? Coordinate with contract negotiators, performs analysis of contracting needs, including assessment of claims and utilization data to identify areas for new and re-negotiated contracts.
? Advise other departments of new contracts and amendments, including updating of all internal systems and processes.
? Review implementation to ensure contract is appropriately administered.
? Ensure timely administration/implementation of contract terms.
? Research, analyze and resolve complex problems dealing with hospital or provider inquiries
? Maintain and manage letters of intent from prospective providers
? Maintain contract templates and amendments and ensures templates are compliant with State and Federal law, internal operations, products and financial requirements.
? Represent department in internal and external audits.
? Continually seek out opportunities for functional improvement and improved business processes.
? Attend Luncheons or after hour meetings for IPAs when pertaining to contracting.
? Handle contracting and credentialing needs when provider joins or leaves group
? Perform other duties as assigned.

Requirements

Qualifications and Experience:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are reflective of the knowledge, skill, and/or ability required.
? Bachelor?s Degree
? 2-5 years of extensive experience in contract negotiations
? Strong sales and negotiation skills
? Advanced knowledge of Insurance types
? Excellent oral and written communication skills
? Strong relationship building skills to influence and work collaboratively with physicians and other provider leaders

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Individual will be required to:
? Sit for long periods at a time.
? Stand for long periods at a time.
? Use hands and fingers in repetitive motions, daily.
? Ability to lift, push, pull up to 20 lbs. periodically.
? Travel to clinic locations or sites as needed.
? Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Job Type: Full-time

Benefits
? 401(k)
? Dental insurance
? Health insurance
? Paid time off

Schedule
? 8 hour shift
? Monday to Friday

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