Credentialing & Contract Manager
US Heart and Vascular
full-time
Posted on:
Location Type: Office
Location: Chicago • Illinois • 🇺🇸 United States
Visit company websiteSalary
💰 $65,000 - $85,000 per year
Job Level
JuniorMid-Level
About the role
- Collect, verify, and maintain documentation for the credentialing and recredentialing of healthcare providers.
- Conduct background checks and review professional references.
- Ensure timely and accurate completion of credentialing applications, including CAQH, state Medicaid programs, Medicare PECOS, hospital medical staff offices, and commercial payer portals.
- Maintain up-to-date knowledge of state, federal, and accreditation requirements (e.g., CMS, NCQA, Joint Commission).
- Ensure compliance with organizational policies and credentialing standards.
- Maintain and update provider credentialing databases and tracking tools.
- Generate reports and track the status of credentialing and privileging applications with hospitals and health plans.
- Serve as a point of contact for healthcare providers regarding credentialing requirements, timelines, and status updates.
- Collaborate with clinical, administrative, and onboarding teams to facilitate seamless provider integration.
- Identify opportunities to optimize workflow in credentialing processes.
- Participate in training and development activities related to credentialing best practices.
- Assist in the coordination, preparation, and submission of payer enrollment forms, contract documents, amendments, and rate updates.
- Maintain contract documentation, payer correspondence, fee schedules, effective dates, and payment terms in centralized repositories.
- Track contract status across all practices, including renewals, expirations, delegated agreements, and participation changes.
- Support analysis of payer contracts, fee schedules, and reimbursement terms to identify gaps, discrepancies, or risks.
- Prepare summaries, comparison sheets, or redlines to support leadership decision-making and negotiation strategy.
- Collaborate with payers to resolve contract setup issues, enrollment errors, rate loading discrepancies, or network status delays.
- Assist in gathering utilization, rate, and policy information needed for contracting initiatives.
- Monitor payer policy updates, reimbursement changes, and regulatory requirements relevant to contracting work.
- Support cross-functional teams including Revenue Cycle, Operations, and Finance to ensure contract terms are operationally executable.
- Participate in payer meetings, contract implementation reviews, or special projects as assigned.
Requirements
- Bachelor’s degree in healthcare administration, business, or a related field preferred.
- Minimum of 2 years of experience in credentialing, contracting, payer enrollment, or a related healthcare administrative field.
- Familiarity with medical terminology, healthcare regulations, and payer structures.
- Strong organizational skills and high attention to detail, with the ability to manage multiple priorities simultaneously.
- Excellent verbal and written communication abilities.
- Proficiency in credentialing software, payer portals, and Microsoft Office Suite (Excel proficiency strongly preferred).
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
credentialingpayer enrollmentcontractingbackground checksreport generationworkflow optimizationdata analysismedical terminologyhealthcare regulationsattention to detail
Soft skills
organizational skillscommunication skillscollaborationtime managementproblem-solving
Certifications
Bachelor’s degree in healthcare administrationBachelor’s degree in business