Credentialing & Contracting Analyst

Woods Services•Lower Makefield Township, PA

6d•Onsite

About The Position

The Contracts and Credentialing Administrator is responsible for maintaining contracts and provider profiles in all applicable systems as well as submitting all credentialing and re-credentialing applications for his/her assigned WSOC portfolio. S/he is responsible for managing payer contracts and the credentialing and re-credentialing of facilities, licensed clinicians and prescribers. This role is integral to supporting the revenue cycle by ensuring that all credentialing and contracting requirements are fulfilled. The Contracts and Credentialing Administrator will report directly to two individuals, the VP of Medical Billing and VP of Administration. The Contracts and Credentialing Administrator must be must be extremely organized and detail oriented.

Requirements

Bachelor’s degree in business or a related field of study
Highly proficient in MS Excel
Proven ability to pick up on systems and document processes
Ability to self-manage, motivate and to not hesitate to ask for assistance
Demonstrated success in working in as a member of a team
Strong organizational skills with attention to detail
Ability to multi-task, problem solve and meet deadlines

Responsibilities

Manage and maintain the credentialing, provider application, and re-credentialing process for all licensed clinicians and prescribers within mental health outpatient, substance use outpatient, and intensive outpatient programs. Coordinate with HR who initializes new hires.
Update and maintain accurate provider profiles in CAQH and other credentialing systems.
Submit credentialing applications and monitor progress with MCOs, commercial insurance providers, and other entities.
Reviews and resolves credentialing issues and contacts insurance carriers to verify/validate requirements to ensure accuracy and avoid potential denial.
Validates all necessary licenses and codes to ensure they are valid for scheduled services.
Provides timely updates to each provider’s file according to the schedule published by CMS.
Completes re-credentialing applications for Governmental payers and Commercial Payers, as necessary.
Ensure records of provider credentials, including NPI numbers, DEA registrations, Medicaid numbers, and licensure, are accurate and current.
Collaborate with managed care organizations and insurance providers to secure and sustain network participation.
Address payer-specific issues that may delay reimbursement, such as credentialing lapses or authorization issues.
Regularly review payer policies and communicate updates to minimize revenue cycle disruptions.
Monitor revenue cycle metrics tied to credentialing and provide actionable insights for improvement.
Ensure processes adhere to state and federal regulations, including New Jersey Medicaid.
Conduct regular audits of provider profiles and payer authorizations for accuracy and compliance.
Prepare and present metrics on credentialing and authorization activities to agency leadership.
Support the contracting process to meet payer compliance requirements.
Monitor contract renewals and address any changes or concerns from payers.
Maintains strict confidentiality on all client records and business-related records, as required under HIPAA guidelines.
Other duties as assigned.