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Provider Credentialing Specialist
Provider Credentialing SpecialistNorthwell Health • Bronx, NY, United States
Provider Credentialing Specialist

Provider Credentialing Specialist

Northwell Health • Bronx, NY, United States
11 hours ago
Job type
  • Full-time
Job description

Flexstaff is hiring a Provider Contract Specialist to join our client's team. This is a long term assignment.The Provider Contracting Specialist is responsible for the development, negotiation, and management of contracts with providers.

Location : Olinville

Setting : Hybrid, 1-2 days in office, schedule can change at any time, so flexibility is required.

Pay Rate : $27 / hr

Schedule : Monday - Friday 8 : 30 am-5 : 30 pm (1 hour lunch)

Contract Length : Temp

JOB RESPONSIBILITIES :

  • Develop, negotiate, and manage contracts with IPA's, primary care

practices, specialty practices, LHCSA agencies, FQHC's, ancillary

providers, hospital systems and other provider groups.

  • Track and monitor provider performance to ensure contracts meet the
  • organization's objectives, including financial terms, compliance, and

    quality of care requirements.

    JOB DESCRIPTION

  • Track and manage contract terms and renewals to ensure timely
  • execution.

  • Administer the on-boarding of new providers through the SCA process,
  • data enter and update provider contracting tracker (PORF) and Care

    Compass. Track and monitor each SCA to ensure the closing of the SCA

    through contract conversion or termination.

  • Maintain accurate records of contract negotiations, amendments, and
  • renewals in the contract management system.

  • Collaborate with internal teams, including legal, compliance, and
  • finance, to draft, review, and finalize provider contracts.

  • Assess and analyze provider performance and market conditions to
  • support negotiation strategies.

  • Respond to provider inquiries and resolve contract-related issues in a
  • timely and professional manner.

  • Ensure compliance with all relevant federal and state regulations, as well
  • as organizational policies and procedures.

  • Assist in the development of provider networks by identifying new
  • potential providers and building relationships.

  • Monitor and report on key performance metrics related to provider
  • contracting and network development.

  • Provide training and guidance to internal teams regarding contracting
  • processes and best practices.

  • Performs job responsibilities according to organization's policies. Seeks
  • clarification when needed.

  • Assumes responsibility for assignments given, seeks supervision
  • appropriately, and is accountable for work performance. Meets

    productivity guidelines.

  • Maintains proper documentation (updated, timely, legible) related to
  • patient care, whether paper or electronic.

  • Maintains HIPAA standards and confidentiality of PHI.
  • Other duties as assigned.
  • Service Standards

  • Timely and Accurate Contract Negotiation
  • QUALIFICATIONS :

    Education : Bachelor's degree in Business Administration, Healthcare

    Management, Finance or related field preferred or equivalent

    combination of education and experience.

    Experience :

  • 1-2 years of experience in healthcare provider contracting, managed
  • care, or a related role.

  • Vendor / provider contracting experience is strongly preferred.
  • Working knowledge of Medicare and Medicaid is required. Health
  • plan / managed care setting, preferred.

  • Experience in administrative support roles that involve data entry,
  • documentation, or working with data is required.

  • Attention to detail, critical thinking, time management skills, a sense of
  • urgency.

  • Strong interpersonal and communication skills with the ability to work
  • collaboratively across departments.

  • Discretion with highly sensitive information, including credentialing files,
  • sanction lists, claims, and remittance information.

  • Attention to detail and ability to maintain accurate records.
  • Excellent organizational and time-management skills.
  • Knowledge of Healthcare regulations (i.e.- HIPAA, CMS, etc.) and a
  • commitment to patient data privacy and security.

  • Proficiency with Microsoft Office Suite (Excel, Word, PowerPoint) and the
  • ability to learn contract management software quickly.

    Additional Salary Detail

    The salary range and / or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining a team member's base salary and / or rate, several factors may be considered as applicable (e.g., location, specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget and internal equity).

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