Contracts & Credentialing Paralegal
About The Position
We are seeking an experienced and detail-oriented Contracts & Credentialing Paralegal to oversee payer contracting, enrollment, and credentialing operations. In this role, you will manage all payer relationships including managed care, Medicaid, Medicare, commercial insurance carriers, school districts, and private payers, while maintaining accurate contract records, chargemaster data, and fee schedules. You will lead and coordinate the credentialing and re-credentialing process for all employed clinical providers, ensuring compliance with accrediting bodies, regulatory agencies, and applicable statutes. This role is also responsible for maintaining the accuracy and integrity of the credentialing database and supporting the organization’s commitment to regulatory compliance and operational excellence.
Requirements
- Bachelor’s degree preferred; at least 3+ years of experience, with a preference to individuals with experience directly related to a hospital, physician group, managed care or outpatient practice credentialing.
- Demonstrated ability to effectively communicate both written and verbally required.
- Ability to think and work independently, meet deadlines and ensure that assigned projects are completed in a timely and efficient manner.
- Effective interpersonal skills.
- Working knowledge of Microsoft Office suite.
- Valid driver’s license required in incumbent’s name
Nice To Haves
- National Association Medical Staff Services (NAMSS) certification as a Certified Medical Services Manager (CPMSMS) or Certified Provider Credentials Specialist (CPCS).
Responsibilities
- Contracting:Prepares documentation for all payor applications and contracts, including, but not limited to: commercial payor initial and re-credentialing applications, annual government contract renewals (both State and Federal), Medicaid applications and revalidations, MLTSS, other State payors, including, but not limited to, NJ DDD, NJ DHS, NJ CSOC, PA DDD, PA DHS, PA Medicaid, DE DDD, IL DDD, school districts, private pay
- Maintains file of required reference documents and obtains updated versions from source departments as needed; protects confidentiality of same
- Maintains inventory of all contracts and fee agreements; updates and manages payor contracts in Contract Lifecycle Management (“CLM”) database in Workday
- Prepares/maintains/updates contract summaries
- Maintains contracting calendar, scheduling renewals, re-contracting, etc.
- Prepares contract summaries with key terms, etc., for presentation to and review by senior leadership for use for new and renewal contracts
- Maintains record of all organizational Medicaid provider numbers and NPI numbers
- Prepares and revalidates new group home applications, including NPI numbers
- Reports diversity data quarterly or more frequently, if required, to payors and governmental entities
- Other duties as assigned
- Credentialing:Leads organizational and individual provider credentialing to ensure participation, including, but not limited to: Medicare, Medicaid, managed care insurance providers
- Establish CAQH accounts for onboarding clinical providers and complete all CAQH applications
- Maintain database of all credentialed providers with relevant, supporting documentation
- Research and resolve any credentialing issues; manage deactivation of provider numbers
- Maintain and verify demographic information
- Privileging:Leads the process for practitioner applications, including accompanying documents, toensure applicant eligibility
- Processes requests for privileges, ensuring compliance.
- Prepares credential files for presentation to Clinical Executive Group
- Monitors the initial, reappointment and expiration process for all employed clinical providers, ensuring compliance with regulatory bodies
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Number of Employees
1,001-5,000 employees
