Provider Credentialing & Contracting Coordinator

Group Health Cooperative of South Central Wisconsin • Madison, WI

16d • Hybrid

About The Position

The Provider Credentialing & Contracting Coordinator is responsible for supporting provider contracting, credentialing, and administrative functions at Group Health Cooperative of South Central Wisconsin. The primary focus of this role is assisting in negotiating and maintaining provider contracts, serving as the main contact for provider inquiries, overseeing contract setup and auditing, analyzing contracts for potential renegotiation and training providers in the use of self-service tools for insurance administration activities. In addition to contracting responsibilities, the specialist assists with the credentialing and recredentialing processes and ensures compliance with NCQA standards for Delegated Credentialing Agreements. The Provider Contracting and Credentialing Specialist will work under the guidance of the Chief Strategy and Business Development Officer.

Requirements

• Associate’s or Bachelor’s degree in business, healthcare administration or a related field or an applicable combination of education and work experience required. Bachelor’s Degree preferred.
• Must be able to understand contract language and provider payment methodologies.
• Knowledge of or ability to learn National Committee for Quality Assurance (NCQA) and/or Joint Commission on Health Care Organizations (JCHCO) standards required.
• Strong interpersonal and communications skills and the ability to work effectively with a wide range of constituencies in a diverse community required. Ability to be culturally sensitive and to work with diverse populations.
• Strong customer service skills and the ability to maintain an excellent rapport with providers and their staff
• Time management skills and flexibility to work on multiple projects/assignments simultaneously, with ability to change focus as business needs dictate. Willingness to assume diverse duties and challenges
• Knowledge of and proven proficiency in the use of Microsoft Office applications including Word, Outlook, Excel and PowerPoint is required. Knowledge of and/or ability to learn and use computer based applications/software such as electronic time and attendance systems. Ability to use the Internet to obtain information and conduct research.
• Ability to build and maintain relationships with internal and external partners.
• Excellent written and verbal communication and interpersonal skills. Ability to speak and listen in person and in virtual meetings.
• Ability to maintain patient, employee and proprietary confidentiality required. Knowledge of or ability to learn HIPAA requirements.
• Ability to pay attention to detail required.
• Ability to work comfortably and routinely as part of a team and to cooperate across organizational boundaries.
• Professional manner necessary to deal courteously and effectively with customers and external partners.
• Possession of a valid Wisconsin Driver license with a good driving record. Access to transportation and ability to travel.
• Ability to maintain patient confidentiality required. Knowledge of medical records and appropriate documentation requirements. Knowledge of HIPAA requirements.

Nice To Haves

• Credentialing certificate preferred but not required. As a condition of employment, incumbent may be required to obtain certification within a reasonable time period.
• Knowledge of and familiarity with medical terminology preferred.

Responsibilities

• Assisting in negotiating and maintaining provider contracts
• Serving as the main contact for provider inquiries
• Overseeing contract setup and auditing
• Analyzing contracts for potential renegotiation
• Training providers in the use of self-service tools for insurance administration activities
• Assisting with the credentialing and recredentialing processes
• Ensuring compliance with NCQA standards for Delegated Credentialing Agreements

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: Associate degree
• Number of Employees: 501-1,000 employees