Credentialing And Payer Contracting Specialist

Responsibilities:

• Completing financial impact analysis of contract negotiations, including modeling of contract proposals, reporting of contract proposal impact, performance and quantifying financial impact of these proposals for future year(s) and developing alternative proposals within the budget parameters. Presenting analysis and recommendations to leadership.

• Interpret managed care contract terms and validates understanding with the contract negotiator. Review all Managed Care contracts and amendments as received to ensure that all contracts in CareCloud are current and calculating correctly.

• Analyze contracts and prepare all supporting schedules necessary to update/maintain the CareCloud system on a current basis. This includes but not limited to: reviewing all new contracts/amendments, communicating with the payors to receive all updates on current basis, researching and downloading data form payor sites, analyzing and comparing new fee schedules to the prior fee schedules, preparing all uploads, validating input and updating CareCloud reimbursement contracts.

• Manage and maintain provider information in a centralized location and platform.
• Other related duties as assigned.

Requirements:

Minimum two years of experience in credentialing for Physician practice and/or Managed Care Insurance Enrollment, Medicare and Medicaid.

Working knowledge of CAQH.

Knowledge of payer credentialing process, ability to organize and prioritize work and manage multiple priorities, excellent verbal and written communication skills, ability to research and analyze data, work independently, and establish and maintain effective working relationships essential.

Communicates appropriately with Physician’s regarding Credentialing and insurance enrollment for new providers and new practices with government and commercial insurance carriers.

Proficient computer skills - Microsoft Office, Excel, and Word.

Knowledge of insurance company operating procedures and practices.

Ability to work pleasantly with physicians, insurance representatives, staff and others.

Job Type: Full-time

Pay: $40,000.00 - $50,000.00 per year

Benefits:

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

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Work Location: Hybrid remote in Spring, TX 77380