Credentialing & Contracting Specialist

VieMed Healthcare•Lafayette, LA

About The Position

The Credentialing & Contracting Specialist is responsible for the comprehensive management of credentialing, contract, revalidation, and other payer documents. This includes processing documents for new in-network agreements, renegotiations, and routine maintenance. A key aspect of the role involves B2B business development, focusing on converting out-of-network payers into in-network contracts, negotiating rate increases, driving patient steerage, and fostering strong payer relationships. The specialist will handle the entire sales cycle, from initial contact and follow-up to escalations, meetings, and negotiations. This position requires meticulous tracking of credentialing and recredentialing deadlines using internal platforms like Salesforce and SharePoint, monitoring submission statuses, and troubleshooting network issues directly with payer partners. The role also involves communicating updates to both external payers and internal teams, ensuring timely escalation of documents for signature, and maintaining organized filing systems for all returned amendments and contracts. Additionally, the specialist will support executive leadership and colleagues with special projects as assigned.

Requirements

3+ years of Healthcare Credentialing Experience.
Highly self-motivated, able to drive pipeline leads from first contact to execution, business development projects from planning to completion.

Nice To Haves

College Degree in a related field preferred but not required.
Proven work experience as a Credentialing Coordinator or similar role.
Proven work experience in payer contracting, relationship development, and rate negotiations.
Durable Medical Equipment (DME) knowledge a plus.
Excellent verbal and written communication skills.
Expertise with Microsoft Office products and Salesforce.
Proficient touch-typing skills.
Ability to focus for extended periods.

Responsibilities

Main Job function entails filling out and processing credentialing, contract, revalidation and other payer documents for New In-Network agreements, renegotiations, and routine upkeep.
Assist with processing LOIs, applications, contracts, and credentialing for our company with new payers/health plans.
Work in a B2B business development capacity on targeted potential and existing contracts as assigned, starting from initial contact, follow-up, escalations, meetings, and negotiations with the goals of turning Out-Of-Network payers into In-Network contracts, rate increases, patient steerage, and maintaining payer relations and contracts.
Process, send, and follow-up on letters of interest, communications, applications, credentialing information, amendments, and other payer documents required to complete the sales cycle.
Schedule, attend, execute remote (web based) and in-person meetings with targeted potential and existing contracted providers nationwide to further the company contracting footprint and deepen payer relationships.
Assist with processing LOIs, applications, contracts, and credentialing for our company with new payers/health plans.
Detail orientated, efficient, and produces error free, timely work.
Track credentialing and recredentialing deadlines within Company task tracking platform (Currently Sales Force and Share Point).
Monitor and track submissions and status changes with payers and update internal records.
Support and Troubleshoot Network Status issues communicated by internal team members directly with our Payer Partners via email, phone, and web portals.
Communicate updates to existing payers and internal team members.
Ensure all documents for signature, including all credentials, amendments, and all material correspondence are escalated to the appropriate person within 1 business day of receipt for completion.
File all returned amendments and contracts from the payers/plans within the company’s current filling system.
Support executive leadership and colleagues with special projects and perform other duties as assigned.