Job description

SUMMARY: Dual Roles: 1. Coordinates physician and allied health professional credentialing and enrollment activities with Medicare, hospitals, health plans, and other regulatory organizations. This role prepares and submits credentialing applications, maintains credentialing records, and supports physicians’ medical and DEA license renewals, CME tracking, and re credentialing as needed. 2. First-line review for all contracts in support of Executive Administrator (J.D.) including maintaining terms and conditions of all contracts in a contract management program. Primary Responsibilities 1. Prepares and submits initial/on-boarding credentialing and re-credentialing enrollment applications for physicians and allied health professionals with hospitals, health plans, Medicare, and commercial insurance carriers. 2. Ensures the Medicare enrollment status for each physician and the entity is complete, accurate, and up-to-date at all times. Responds timely to any and all correspondence received from Medicare. 3. Submits new provider information and updates to the National Provider Identifier (NPI) registry and Council for Affordable Quality Healthcare (CAQH). 4. Maintains credentialing files for physicians and allied health professionals including licenses, CME, certifications and regulatory documentation. Monitors expiration dates for provider licenses, Drug Enforcement Administration (DEA) registrations, professional liability insurance, and specialty board certifications. Prepares and submits renewal applications and documentation prior to expiration deadlines. 5. Maintains complete, accurate, and up-to-date documentation of provider enrollment records with Medicare and managed care entities. 6. Assists all department managers/directors by providing first-line review of all contracts in a manner that is consistent with the entity’s standards and Executive Administrator’s expectations. Coaches managers on negotiating tips for requested changes on contracts. Such contracts include, but are not limited to: i. Employment agreements; iil Equipment and building maintenance; III. Equipment and building leases; iv. Bank loans and mortgage loans; v. Software support services; vi. Contracts with payors and managed care organizations; vii. Supplier contracts; and viii. Service agreements 7. Assists in identifying and handling start-up implementation for a contract management system. 8. Maintains all data in contract management system and follows-up as needed on tracking and maintaining finalized, fully executed contracts. Enters all terms and conditions in contract management system including, but not limited to, terms of contract, renewal terms, termination terms and notice periods/process, price escalation agreements, and insurance requirements including current proof of insurance. 9. Performs all other duties as assigned. Education and Experience • Associate degree in Paralegal Studies or related field required; Bachelor’s degree in Paralegal Studies preferred. • ABA-approved paralegal certificate required. • Experience with physician credentialing, Medicare enrollment, and healthcare administration required. • Experience with contract review, management, and negotiation required. Required Skills and Abilities • Strong organizational and time management skills. • Strong attention to detail • Effective written and verbal communication skills. • Ability to maintain confidential and sensitive information. • Ability to coordinate multiple tasks and deadlines simultaneously. • Strong customer service skills when interacting with physicians, management team, and administration. • Professional interpersonal skills with the ability to interact effectively with leadership, physicians, and peers. • Proficiency in Microsoft Office (Word, Excel, Outlook, and PowerPoint). Physical Requirements • Ability to sit for extended periods while working at a computer workstation; • Frequent use of hands and fingers for typing, data entry, and phone use; • Ability to speak clearly and hear well enough to communicate by phone and in person; • Occasional standing, walking, bending, and reaching; • Ability to lift and carry up to 25 pounds (files, office supplies); • Visual acuity to read computer screens; and • Ability to focus for long periods and manage high-volume, detail-oriented tasks.

Requirements

Must-haves

Coordinates physician and allied health professional credentialing and enrollment
activities with Medicare, hospitals, health plans, and other regulatory organizations. This
role prepares and submits credentialing applications, maintains credentialing records, and
supports physicians’ medical and DEA license renewals, CME tracking, and re
credentialing as needed.
First-line review for all contracts in support of Executive Administrator (J.D.) including
maintaining terms and conditions of all contracts in a contract management program.
Prepares and submits initial/on-boarding credentialing and re-credentialing enrollment applications
for physicians and allied health professionals with hospitals, health plans, Medicare, and
commercial insurance carriers.
Ensures the Medicare enrollment status for each physician and the entity is complete, accurate,
and up-to-date at all times. Responds timely to any and all correspondence received from
Submits new provider information and updates to the National Provider Identifier (NPI) registry and
Council for Affordable Quality Healthcare (CAQH).
Maintains credentialing files for physicians and allied health professionals including licenses, CME,
certifications and regulatory documentation. Monitors expiration dates for provider licenses, Drug
Enforcement Administration (DEA) registrations, professional liability insurance, and specialty
board certifications. Prepares and submits renewal applications and documentation prior to
expiration deadlines.
Maintains complete, accurate, and up-to-date documentation of provider enrollment records with
Medicare and managed care entities.
Assists all department managers/directors by providing first-line review of all contracts in a manner
that is consistent with the entity’s standards and Executive Administrator’s expectations. Coaches

Nice-to-haves

Studies preferred.

Application prep

Use the role’s language and application details while tailoring your materials.

Platform: bamboohr
Effort: medium