Medical Contracting & Credentialing Specialist

Rising Ground, Inc.•New York, NY

2d•Onsite

About The Position

The Contracting and Credentialing Specialist handles managing the contracting and credentialing process for Rising Ground’s managed care programs and providers with various insurance payors. This role involves negotiating contracts, ensuring compliance with regulatory requirements, and maintaining accurate provider information.

Requirements

Associate or bachelor’s degree in healthcare administration or equivalent, preferably
Minimum of 2-3 years’ experience in healthcare contracting and/or credentialing
Familiarity with healthcare insurance terminology and reimbursement methodologies
Excellent negotiation and communication skills
Proficient in Microsoft Office and other relevant software
Authorized to work in the U.S.
Ability to travel to other Rising Ground sites (if required)

Responsibilities

Participate in the negotiating and completion of contracts with insurance payors, ensuring favorable terms for the programs
Aid in analyzing contract language to identify potential risks and opportunities.
Ensure compliance with all applicable federal and state regulations related to contracting and credentialing
Maintain accurate and organized records of contracts, credentialing applications, and other relevant documents
Submit credentialing applications to insurance payors and follow-up on status
Manage contract renewals and amendments
Collect, verify, and maintain provider credentials, including licenses, certifications, and experience
Maintain up-to-date provider information in credentialing database (e.g., CAQH, Availity)
Collect all required documentation for credentialing such as accreditations, membership, facility privileges (e.g., Designations letters)
Build and maintain positive relationships with insurance payor representatives
Resolve contract disputes and billing issues efficiently