Credentialing Specialist

Summary of JD:

We are seeking a Credentialing Specialist who will be responsible for drafting contracts, task orders, work requests, preparing bidding documents, or any other type of document that would be necessary in order to acquire goods or services from a supplier.

Responsibilities:

• Must continue to honor the company’s core values and mission statement.
• Provides updates during weekly meeting with Lab, Sales and Manager
• Contributes to the development of processes and procedures
• Provide feedback on department meetings regarding contracting and credentialing.
• Perform contracting for Billing and Lab and oversee contracting process with external vendors.
• Research all contracts for accuracy with Billing and Lab
• Develop, negotiate and maintain contracts with all payers that provide timely notification of critical contract events (e.g. renewals, termination and due dates contained within the agreements).
• Assure contractual arrangements meet financial targets and legal/regulatory compliance requirement.
• Facilitate the approval process of all contract documents from pre-contract post signature phases.
• Maintain existing relationships with contracted providers.
• Ensure contractual language is kept current; evaluate fee schedule on a yearly basis to identify possible opportunities for additional covered services, medical policy changes and reimbursement.
• Coordinate and communicate contractual terms to the billing department; ensure staff is informed of changes in medical policy & billing policies.
• Conduct on-going assessments of assigned networks and make recommendations for strategic initiatives, goals and objectives.
• Develop and maintain periodic, e.g., bi-weekly, reports on the status of all contracts.
• Assure accurate data entry of contract specifications and terms into database and completeness of all contracting processes for billing office and Lab.
• Assist with all contracting administration and projects, as needed.

Requirements:

• BA in business
• 8 years of medical contracts experience
• Must have life science industry experience
• 5 years of Microsoft Office suite
• Must work on-site