Contracts & Credentialing Paralegal

Bancroft•Cherry Hill, NJ

4d•Onsite

About The Position

We are seeking an experienced and detail-oriented Contracts & Credentialing Paralegal. This position supports Bancroft, which is a human services organization serving children, adults with disabilities and individuals with behavioral health needs. In this role, you are responsible for managing payer and provider enrollment and contracts requirements specific to government and community based funding sources. You will oversee all payor contracting and enrollment, including but not limited to: managed care, Medicaid, Medicare, insurance carriers, school districts and private payors.

Requirements

Paralegal certificate or Associates in Paralegal Studies required
at least 3+ years of 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

Bachelor’s degree preferred
National Association Medical Staff Services (NAMSS) certification as a Certified Medical Services Manager (CPMSMS) or Certified Provider Credentials Specialist (CPCS).

Responsibilities

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
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
Leads the process for practitioner applications, including accompanying documents, to ensure 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