Contracting Credentialing Specialist
Job Overview
Contract Specialist is responsible for payor contracting. Skilled in negotiating and renegotiating payor contracts and single case agreements to optimize reimbursement and profitability.
Proficient in organizing and maintaining contract documentation, insurance enrollments, and credentialing files to ensure accessibility and accuracy for all stakeholders. Has effective communication with providers and healthcare organizations, ensuring timely completion of enrollment processes and maintaining up-to-date records of insurance participation.
Responsibilities
- Engage with payors through in-person meetings, phone, virtual, and email to foster strong relationships and negotiate agreements that align with organizational goals and maximize value.
- Negotiate and renegotiate payor contracts and single case agreements to enhance profitability and ensure alignment with current reimbursement standards.
- Manage contract re-credentialing processes to prevent coverage lapses and maintain compliance.
- Organize, store, and maintain contract documentation to ensure accessibility and transparency for all stakeholders.
- Maintain accurate and up-to-date credentialing data for all providers, supporting both initial and re-credentialing efforts.
- Respond to credentialing and privileging inquiries from healthcare organizations in a timely and professional manner.
- Follow up with payors to ensure timely submission of required information and completion.
- Track and update provider participation across insurance plans, including effective dates and plan-specific requirements.
- Perform provider re-credentialing in accordance with individual insurance plan guidelines
Qualifications
· Associates Degree in business or health related field preferred |
· Three years Contracting and Provider Enrollment experience preferred |
· Must be an organized “self-starter” requiring little supervision in order to focus on and accomplish tasks |
Additional Job Information
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About Us
Notice of Use of Artificial Intelligence Tools in the Recruitment Process
At BrightSpring Health Services, our LEGACY culture guides how we lead, how we serve, and how we show up for one another. We are committed to doing the right thing—leading with integrity, accountability, and transparency in all that we do. As part of this commitment, we share that we may use third-party artificial intelligence (AI) to process employment data in connection with our hiring processes. Any AI tool that we use always has humans in the loop; we do not use AI to automate employment decisions or to discriminate, and we do not use zip codes as proxy. Humans – our hiring leaders and recruiter – make final decisions. BrightSpring Health Services provides reasonable accommodations to qualified applicants and employees with disabilities; if you would like to request a reasonable accommodation, please contact your recruiter or send an inquiry to TalentAcquisition@brightspringhealth.com. For more information about how our company uses AI in the hiring process, contact TalentAcquisition@brightspringhealth.com.
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