NRG Management is looking for a full-time Credentialing and Contract Specialist. The Credentialing and Contract Specialist may be familiar with Credentialing Providers In and out of network for Residential Detox, Partial Hospitalization and Intensive Out-Patient care in the Co-Occurring and Substance Abuse field. As a Credentialing and Contract Specialist, you will be responsible for credentialing, re-credentialing and privileging of all applicable medical staff. Also responsible for enrolling providers in all applicable public and private payer organizations. Experience in the Mental Health/Addiction space preferred.
The Opportunity
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Perform all aspects of the credentialing, re-credentialing, and privileging process of applicable medical staff
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Maintain CAQH, PECOS, and NPI registry for all IHTC providers as applicable.
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Maintain copies of current state licenses, CSR and DEA certificates, malpractice coverage, and other required credentialing documents.
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Track license and certification expirations for all providers to ensure timely renewals.
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Coordinate with the Billing Manager to ensure all applicable providers are correctly attached to all existing and new contracts.
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Could you make sure provider demographics are kept updated with all payers?
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Audit health plan directories for current and accurate provider information.
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Manage the development and implementation of new contracts
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Participate in the development of new business, acquisitions, and facility expansion.
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Influence contract strategy in complex contract negotiations and discussions.
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Lead contract discussions with third-party payers, including rate and language negotiation under established guidelines.
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Establish and maintain positive working relationships with third-party payer networks.
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Coordinates the implementation of executed contracts to properly communicate contract requirements/changes internally.
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Review solicitations and prepare routine responses for proposals, bids, and contract modifications, as necessary.
Job Type: Full-time
Expected hours: 40 per week
Benefits:
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401(k)
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401(k) matching
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Dental insurance
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Health insurance
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Life insurance
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Paid time off
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Tuition reimbursement
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Vision insurance
Schedule:
People with a criminal record are encouraged to apply
Education:
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Healthcare Administration degree preferred or meets experience requirements.
Experience:
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Provider Credentialing: 2 years (Required)
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Onboarding Provider: 1 year (Required)
License/Certification:
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Certified Provider Credentialing Specialist (CPCS) (Preferred)
Work Location: In person
- Degree in Healthcare Administration or equivalent experience preferred
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3 years of job-related work experience may be accepted in lieu of degree
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Four years of experience with healthcare provider enrollment and/or credentialing
