Contracts & Credentialing Paralegal

Bancroft•Cherry Hill, NJ

5d•$68,994 - $81,058

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. About Bancroft: For over 140 years, Bancroft has been making a difference in the lives of many. The organization is well known for helping people with disabilities achieve fulfilling lives while improving their function, activity and participation in society. Bancroft’s reputation for excellence is based on its commitment to providing a spectrum of individualized services, treating each person with respect and dignity, and providing services in an encouraging and supportive environment.

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

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, 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