Job Details

Job Type

Full-time

Description

The Contracting & Credentialing Specialist, under the supervision of the Director of Finance & Billing, is responsible for leading provider and facility licensing, credentialing, and contracting across all applicable regions and health plans. The Contracting & Credentialing Specialist will work cooperatively with many teams including Billing, HR, Recruiting, Providers, Operations, and the Owners, to ensure timely and accurate contracting and credentialing to meet staffing and facility needs in a rapidly growing organization.

Essential Functions (not all inclusive)

• Lead all provider and facility licensing, credentialing, and contracting necessary to ensure claims are paid and cash flow is not disrupted.
• Develop licensing, credentialing, and contracting workflows and processes as we scale our clinical team across California and potentially other states.
• Maintain tracking databases of required provider and facility licenses, certifications, contract statuses, and credentials; in addition, review and update this critical data and the associated documents on an ongoing basis to ensure compliance.
• Manage AUC's provider roster to mitigate risks associated with growth, drive efficiencies, and advance proactive monitoring and action related to licensing, credentialing, and contracting.
• Monitor and communicate provider and plan statuses, along with barriers related to operational processes, and drive solutions to overcome challenges.
• Provide contracting and credentialing support to various departments, teams, and individuals within the organization as needed to fulfill business needs.
• Track and monitor all executed health plan agreements, work with the Billing Manager to ensure claims are billed correctly per the executed agreement.
• Work with the Billing Manager to ensure new health plan contracts and their associated effective dates are communicated to the appropriate Operations Managers for staff notification and education purposes.
• Communicate the roster of new providers as they are onboarded to the Billing Team, to ensure claim reimbursements are maximized.
• Coordinate new provider credentialing which includes sending welcome emails to new providers, in addition be of assistance for any questions or concerns they may have. Trouble shoot barriers quickly to avoid delays in receiving credentialing approvals.
• Coordinate and manage the Supervising Physician matrix along with the associated agreements, to remain in compliance with the Medical Board and health plan requirements.
• Submit Letters of Intent to health plans or medical groups that we are not yet contracted with; educate and build relationships with health plan groups to help expedite the contracting process.
• Promptly gather and submit required documents for new facility credentialing and contracting to ensure new clinics are contracted by their assigned go live date.
• Perform special projects and other duties as requested.
• Perform other duties as assigned.
• Comply with departmental policies and procedures.
• Responsible for showing up to work on time and being available to all team members including HR, Billing, and Providers during work hours.
• Maintain patient confidentiality and information security, adhere to all HIPAA regulations and requirements.