Contracting and Credentialing Specialist – Contractor

Job Description:

• Manage the contracting and credentialing activities with commercial insurance companies and managed care plans and Medicaid agencies.
• Oversee the complete process of provider enrollment, application, credentialing, through contract execution.
• Ensure that all applications are submitted accurately and followed through aggressively.
• Serve as the point of contact for contract negotiations.
• Maintain persistent follow-up to expedite approvals and contract activations.
• Work closely with Grants, Contracts, Development team, Chief Operating Officers, Program Manager, and Finance to review current plans.
• Make initial contact with provider enrollment for each plan.
• Prepare, submit and track all contracting paperwork, credentialing applications and recredentialing files for all providers and facilities.
• Monitor credentialing timelines, proactively follow-up through the approval and contracting process.
• Maintain an organized tracking system of credentialing statuses, contracting progress, rate agreements, and renewal deadlines.
• Attend regular meetings to provide regular reports to leadership regarding credentialing/enrollment completions, contracting process and outstanding issues.
• Develop effective working relationships with credentialing and contracting representatives.
• Work with the Amity services faculty in Pima County to gather and verify specific information needed for applications in Arizona.
• Work with the Amity Enhanced Care Management and Community Supports faculty to gather and verify specific information needed for applications in California.
• Ensure that all draft contracts are sent to and reviewed by relevant Amity services, finance, legal, people operations, data and executive teams.
• Ensure that all fully executed contracts are uploaded to the Amity contracts repository and are also sent to all relevant teams.
• Stay up to date on Medicaid guidelines, commercial insurer requirements and industry best practices related to credentialing and contracting.

Requirements:

• Bachelor’s degree in business administration, healthcare management or related field preferred.
• 3+ years of work experience in credentialing and contracting within healthcare
• Proven ability to successfully manage provider credentialing workflows and securing insurer contracts.
• Strong organizational skills with the ability to manage multiple credentialing files and contracts simultaneously.
• Excellent communication skills with persistence, assertiveness and a results-driven approach.
• Proficiency with Microsoft Office Suite and credentialing and contracting portals.
• Highly detail-oriented with zero tolerance for errors in credentialing documentation.
• Self-motivated, disciplined, and comfortable in deadline-driven environment.
• Understanding of California Advancing and Innovating Medi-Cal (Cal-AIM) for the justice-involved population.
• Understanding of the Arizona Health Care Cost Containment System (AHCCCS) for behavioral health services.
• Understanding of regional community-level needs with regards to social services for the justice-involved population.
• Within 90 days of hire, personnel file shall document evidence of participation in the following trainings:
• Los Angeles County – required trainings (as needed)
• Pima County – required trainings (as needed)
• Participate in additional trainings as required
• Exceptional organizational and project management skills, with the ability to independently coordinate and lead multiple projects simultaneously focusing on quality and project follow-through.
• Ability to establish effective working relationships with staff, groups, agencies, officials, departments, and boards and manage expectations and priorities from various partners.
• Ability to interpret rules, regulations, guidelines, and legislation as they pertain to credentialing and contracting responsibility.
• Ability to retain and recall information regarding accounting systems and reporting requirements.
• Strong judgement in regard to how to manage sensitive topics.
• Analytical, database and reporting skills along with ability to prepare recommendations for courses of action.
• Ability to craft or update policies and procedures with a sharp eye for accuracy and detail.
• Exceptional organizational and project management skills, with the ability to independently coordinate and lead multiple projects simultaneously focusing on quality and project follow-through.
• Ability to frame issues and communicate technical, budgetary, and program details across all functions and to various partners.
• Confidence to ask pertinent questions to grasp concepts quickly and think beyond specific tasks.
• Superb interpersonal skills with a comfort working across diverse teams and handling senior leaders and use good judgement to resolve issues.
• Excellent written and verbal communication skills.
• Flexibility and ability to learn and develop new skills on the job.
• An ability to balance time efficiently, adhere to strict deadlines and multi-task in a fast-paced environment.
• Highly organized, detail-oriented, and committed to quality.
• Proactive problem solver and a self-starting individual.
• Excel at both working collaboratively and independently.
• Flexible, open, positive, and collaborative personality.

Benefits: