Credentialing and Payor Contracting Specialist (Full-Time)

ChildServe•Johnston, IA

6d•Onsite

About The Position

This is a newly created role responsible for overseeing end-to-end provider and entity credentialing, payor enrollment, and medical staff privileging to ensure timely and accurate participation with Medicaid, MCOs, and commercial payors. The position also supports payor contracting by coordinating contract processes and assisting with financial and reimbursement analysis in partnership with key internal teams.

Requirements

Bachelor’s degree in Accounting, Finance, Economics, or Healthcare Administration with a strong accounting or financial analysis foundation.
2+ years of experience in a financial analyst, contracting analyst, revenue cycle, or healthcare finance–adjacent role with demonstrable analytical responsibility.
Experience in public accounting, internal audit, FP&A, revenue integrity, or healthcare finance.
Ability to understand and communicate effectively and professionally in reading, writing, and speaking the English language.

Responsibilities

Manage end-to-end credentialing and enrollment of organizational entities with Medicaid, MCOs, and commercial payors.
Credential and recredential physicians, advanced practice providers (APPs), and other clinical providers with all applicable payors.
Maintain credentialing timelines to avoid lapses in participation or reimbursement.
Serve as the primary point of contact with payors for credentialing-related inquiries, follow-ups, and issue resolution.
Maintain accurate provider and entity data in credentialing systems, CAQH, and internal databases.
Provide administrative support for hospital medical staff credentialing and privileging processes.
Compile, submit, and track required documentation for initial and ongoing privileges.
Monitor expiration dates and renewal cycles to ensure continuous compliance with hospital and regulatory requirements.
Coordinate communication between providers, hospitals, and internal stakeholders related to privileging status.
Assist with the financial review and analysis of payor contracts in coordination with the Director of Revenue Cycle and the VP of Government Relations.
Support evaluation of reimbursement methodologies, rate structures, and contract terms.
Help prepare summaries, comparisons, and impact analyses to inform contract negotiations and strategic decision-making.
Maintain organized records of executed payor agreements and supporting financial documentation.
Serve as the central point person for coordinating the intake, tracking, and dissemination of all organizational contracts (payor and non-payor).
Manage and enforce the contract checklist process for contracts entering or exiting the organization, ensuring appropriate review and approvals.
Coordinate with legal, finance, compliance, operations, and executive leadership to ensure contracts move efficiently through the review process.
Maintain a centralized contract repository with accurate status tracking, key dates, and version control.
Support contract renewals, amendments, and terminations by monitoring deadlines and notifying stakeholders.
Ensure all credentialing, privileging, and contracting activities comply with regulatory, accreditation, and internal policy requirements.
Prepare reports and dashboards on credentialing status, contract inventory, expirations, and workflow metrics as requested.
Identify process improvement opportunities and recommend efficiencies in credentialing and contract management workflows.