Original listing text, shown exactly as published by the company.
About the Position
The Contracting and Credentialing Specialist is responsible for managing the contracting and credentialing activities with commercial insurance companies and managed care plans and Medicaid agencies in Pima County, Arizona for residential and outpatient treatment, and in multiple counties in California for the California Advancing and Innovating Medi-Cal (Cal-AIM) Enhanced Care Management and Community Supports services. This role oversees the complete process of provider enrollment, application, credentialing, through contract execution, ensuring that all applications are submitted accurately and followed through aggressively. The specialist serves as the point of contact for contract negotiations while maintaining persistent follow-up to expedite approvals and contract activations.
What You Will Do
- Work closely with Grants, Contracts and Development team; Chief Operating Officers; Program Manager; and Finance to review current plans and design a timeline for additional plans.
- Make initial contact with provider enrollment for each plan.
- Oversee the application and credentialing process.
- Prepare, submit and track all contracting paperwork, credentialing applications and recredentialing files for all providers and facilities with commercial insurance carriers and Medicaid agencies.
- Serve as the primary point of contact for credentialing activities, ensuring accuracy, timelines and compliance requirements.
- Monitor credentialing timelines, proactively follow-up through the approval and contracting process.
- Maintain an organized tracking system of credentialing statuses, contracting progress, rate agreements, and renewal deadlines.
- Attend regular meetings to provide regular reports to leadership regarding credentialing/enrollment completions, contracting process and outstanding issues.
- Develop effective working relationships with credentialing and contracting representatives to streamline processes.
- Work with the Amity services faculty in Pima County to gather and verify specific information needed for applications in Arizona.
- Work with the Amity Enhance Care Management and Community Supports faculty to gather and verify specific information needed for applications in California.
- Ensure that all draft contracts are sent to and reviewed by relevant Amity services, finance, legal, people operations, data and executive teams.
- Ensure that all fully executed contracts are uploaded to the Amity contracts repository and are also sent to all relevant Amity services, finance, legal, people operations, data and executive teams.
- Stay up to date on Medicaid guidelines, commercial insurer requirements and industry best practices related to credentialing and contracting.
- Perform other related duties as assigned.
What You Will Bring
- Education and Experience:
Required
- Bachelor’s degree in business administration, healthcare management or related field preferred.
- 3+ years of work experience in credentialing and contracting within healthcare
- Proven ability to successfully manage provider credentialing workflows and securing insurer contracts.
- Strong organizational skills with eh ability to manage multiple credentialing files and contracts simultaneously.
- Excellent communication skills with persistence, assertiveness and a results-driven approach.
- Proficiency with Microsoft Office Suite and credentialing and contracting portals.
Preferred
- Highly detail-oriented with zero tolerance for errors in credentialing documentation.
- Self-motivated, disciplined, and comfortable in deadline-driven environment.
- Understanding of California Advancing and Innovating Medi-Cal (Cal-AIM) for the justice-involved population.
- Understanding of the Arizona Health Care Cost Containment System (AHCCCS) for behavioral health services.
- Understanding of regional community-level needs with regards to social services for the justice-involved population.
Continuing Education
- Within 90 days of hire, personnel file shall document evidence of participation in the following trainings:
- Los Angeles County – required trainings (as needed)
- Pima County – required trainings (as needed)
- Participate in additional trainings as required
Skills/Abilities
- Exceptional organizational and project management skills, with the ability to independently coordinate and lead multiple projects simultaneously focusing on quality and project follow-through.
- Ability to establish effective working relationships with staff, groups, agencies, officials, departments, and boards and manage expectations and priorities from various partners.
- Ability to interpret rules, regulations, guidelines, and legislation as they pertain to credentialing and contracting responsibility.
- Ability to retain and recall information regarding accounting systems and reporting requirements.
- Strong judgement in regard to how to manage sensitive topics.
- Analytical, database and reporting skills along with ability to prepare recommendations for courses of action.
- Ability to craft or update policies and procedures with a sharp eye for accuracy and detail.
- Exceptional organizational and project management skills, with the ability to independently coordinate and lead multiple projects simultaneously focusing on quality and project follow-through.
- Ability to frame issues and communicate technical, budgetary, and program details across all functions and to various partners.
- Confidence to ask pertinent questions to grasp concepts quickly and think beyond specific tasks.
- Superb interpersonal skills with a comfort working across diverse teams and handling senior leaders and use good judgement to resolve issues.
- Excellent written and verbal communication skills.
- Flexibility and ability to learn and develop new skills on the job.
- An ability to balance time efficiently, adhere to strict deadlines and multi-task in a fast-paced environment.
- Highly organized, detail-oriented, and committed to quality.
- Proactive problem solver and a self-starting individual.
- Excel at both working collaboratively and independently.
- Flexible, open, positive, and collaborative personality.
