Contracting & Credentialing Specialist

The Contract & Credentialing Specialist is held responsible for managing the credentialing, re-credentialing, licensing, and contracting administration processes for providers and organizations, ensuring compliance with legal and regulatory requirements. This includes verifying qualifications, timely submissions and maintaining accurate provider information. Principal Duties and Responsibilities • Manage credentialing, re-credentialing and payer attestations • Ensure adherence to all applicable state, federal and regulatory requirements for credentialing and contracting • Manage all wholesale contracts • Manage and maintain payer portal access for Provider Relations and RCM • Support Medicaid enrollments • Support & maintain all accreditation required documentation for renewals and compliance • Ensure up-to-date business licenses required per state • Manage RCM & Provider Relations expenses and accruals • Maintain accurate and up-to-date provider information in databases, ensuring timely updates and reporting • Support RCM by managing and maintaining EFT portal access and payer enrollment for claims submissions • Have a comprehensive understanding of the coding, coverage and payment components of assigned product lines • Maintain & update payer database with current fee schedules including government, workers’ compensation, auto and commercial • Support Provider Relations regarding new contractual agreements with government and private payers in the health insurance and workers’ compensation areas to open new sources of business for products