About this position
About the Role
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.
What You’ll Do
- 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
Your Qualifications
- 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
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.
Supervisory Responsibility
No
Work Environment:
Clinic/Field/Corporate Office
Position Type/Expected Hours of Work:
This is a full-time position. Days may vary and hours of work in our Brooklyn Hub at 151 Lawrence Steet Brooklyn, NY 11201. Work hours are 9:00 am - 5:00 pm.
Additional Requirements:
- Authorized to work in the U.S.
- Ability to travel to other Rising Ground sites (if required)
11 Paid Holidays
Paid Sick Time
Paid Vacation
Paid Personal days
Equal Employment Opportunity Statement
It is the policy of Rising Ground that the Agency wholly complies with equal treatment of all employees and applicants for employment without unlawful discrimination as to an individual’s perceived or actual race, creed, color, national origin, alienate, citizenship status, gender, age, disability, marital status, partnership status, sexual orientation, ethnicity, religion, or veteran status in all employment decisions, including but not limited to recruitment, hiring, compensation, training and apprenticeship, promotion, upgrading, demotion, downgrading, transfer, layoff and termination and all other terms and conditions of employment.
Salary Information