Key Responsibilities:

• Credentialing:
• Oversee the entire credentialing process for new and existing providers.
• Ensure all provider credentials are verified and maintained according to organizational policies and procedures.
• Coordinate with providers to obtain necessary documentation and information.
• Monitor and track credentialing applications, ensuring timely processing and renewals.
• Maintain accurate credentialing records in the credentialing database/system.
• Ensure compliance with state, federal and accrediting body requirements.

2.Contract Management:

• Prepare, review and manage contracts with providers, payers and other healthcare entities.
• Ensure contracts are compliant with organizational standards and regulatory requirements.
• Track contract terms, renewals and expirations.
• Collaborate with legal, compliance and finance departments to resolve contract issues.
• Maintain a comprehensive contract database and ensure all contracts are up-to-date.

3.Compliance:

• Stay informed about changes in regulations and accreditation standards related to credentialing and contracting.
• Conduct periodic audits of credentialing and contract records to ensure compliance.
• Assist in developing and updating policies and procedures related to credentialing and contracting.

4.Communication and Collaboration:

• Serve as a liaison between providers, payers and internal departments regarding credentialing and contract issues.
• Provide training and support to providers and staff on credentialing and contracting processes.
• Address and resolve provider inquiries and concerns in a timely manner.

5.Reporting:

• Generate regular reports on the status of credentialing and contracting activities.
• Present findings and recommendations to management as needed.
• Track and report key performance indicators (KPIs) related to credentialing and contracting processes.