Credentialing and Contracting Specialist

We are looking for a Credentialing & Contracting Specialist to support the needs of our Insurance Department.

Summary

LittleStar ABA is dedicated to providing quality care to our patients, and we are looking for a compassionate and experienced Credentialing and Contracting Specialist who wants to grow with our company! The Credentialing and Contracting Specialist is responsible for negotiating, enrolling, and maintaining all insurance contracts that LittleStar partners with. Credentialing and Contracting Specialists develop new contracts with payers and expands services with payers that have existing contracts to help our patients. This individual leads the entire contract process from pre-contract through post-signature phases, closely collaborating with the insurance team and other internal departments to ensure staff are informed and payer policies are updated.

GREAT BENEFITS

• Three options for medical and two options for dental (50% paid by LittleStar). Vision (100% paid by LittleStar)
• Free health and wellness clinics for eligible staff (with free generic medications)
• Generous paid time off, 15 days for first year of employment and another day added for each subsequent year
• Nine paid holidays
• 401k with company match
• This position is eligible to work from home up to 60% of the time
• Healthy work life balance, hours are typically Monday through Friday 8ish to 4:30ish with some flexibility

Essential Duties and Responsibilities of a Credentialing and Contracting Specialist

• Responsible for credentialing all providers in the practice and credentialing facilities with insurance carriers (including Commercial, Medicaid applications and Managed Care). Enroll, maintain, and terminate clinical staff with our insurance contracts.
• Develop, negotiate, and maintain contracts with all payers, e.g., insurance companies, MCEs, and government programs, including researching territories to identify gaps with our payer base. Maintain a roster with insurance companies we contract with.
• Facilitate the approval process of all contract documents from pre-contract through post- signature phases. Correspond with providers, staff, and network provider relations staff to coordinate/confirm network provider participation; communicates provider enrollment information and status.
• Responsible for accurate supporting documentation for contracts.
• Coordinate and communicate contractual terms to the billing department; ensure staff are informed of changes in medical and billing policies.
• Conduct on-going assessments of assigned networks and make recommendations for strategic initiatives, goals, and objectives.
• Develop and maintain reports on the status of all contracts and credentialing as well as maintaining processes that provide timely notification of critical contract events (e.g., renewals, termination and due dates contained within the agreements).
• Meet with providers to gather, review, and provide guidance on completing credentialing packets. Coordinate the accurate input of physician information into CAQH, Medicaid, and NPI databases.
• Continuously verify the status of provider licenses, and specialty certificates.
• Maintain confidentiality of fiscal information.

Educational Qualifications and Skills

• High School diploma or GED required; Bachelor’s degree or equivalent years of experience preferred
• 1-2 years of experience with insurance in a medical office setting highly preferredwith a strong understanding of medical terminology
• Proficient with technology, including Microsoft Office products and Internet research
• A positive team player with the ability to work with a variety of people, both internal and external
• Strong organizational habits, attention to detail and accuracy, excellent time management skills, and the ability to manage multiple tasks
• Must possess analytical problem-solving skills and the ability to work in a fast-paced environment
• Strong communication skills, with ability to respond appropriately and professionally given the circumstances of the situation and audience involved
• Discretion in matters that need to remain private

Condition of Employment

• Must successfully pass the initial and updated criminal history, background, and record checks, which includes driving history checks.
• During times of high rates of COVID transmission, may be required to wear appropriate Personal Protective Equipment (PPE), as provided by LittleStar, where physical distance cannot be attained.

Work Environment

Credentialing and Contracting Specialists operate in a professional office environment. This role routinely uses standard office and audiovisual equipment. Position is eligible to telecommute up to 60% of the time.

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 the Credentialing and Contracting Specialist position.

While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to stand; walk, climb stairs, use hands to finger, handle or feel; and reach with hands and arms. Must be able to lift up to 25 pounds.

Reasonable accommodations can be provided to assist or enable qualified individuals with disabilities to perform the essential functions of the position, upon request.

Mission

To inspire, serve, and guide all those touched by autism to achieve a better reality.

Vision

To be the trusted, innovative, compassionate partner creating new possibilities for individuals touched by autism across their lifespan.

Core Values

Real Care, Real Advocacy, and Real Progress

This Employer Participates in E-Verify and All Offers of Employment are Contingent Upon Clear Results of a Background Check

Job Type: Full-time

Pay: From $21.00 per hour

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Application Question(s):

• Are you able to commute to Carmel at least 1 time a week?
• What are you looking to make at an hourly rate?

Experience:

• credentialing: 1 year (Preferred)

Ability to Relocate:

• Carmel, IN 46032: Relocate before starting work (Required)

Work Location: Hybrid remote in Carmel, IN 46032