Credentialing & Contract Manager

The Credentialing & Contract Manager is responsible for managing the end-to-end credentialing life cycle for healthcare providers and supporting payer contracting activities that strengthen organizational performance. This dual-function role ensures full compliance with regulatory requirements, verifies provider qualifications, and assists with payer contract maintenance, analysis, and coordination. The position plays a critical role in safeguarding the integrity of our healthcare operations while supporting contractual alignment across our payer networks, hospitals, and affiliated entities.

• 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.

• 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).

• Certification from a recognized credentialing organization (e.g., CPCS, CPMSM) a plus.
• Experience analyzing payer contracts or fee schedules, or working with contracting or revenue cycle teams.
• Strong analytical or spreadsheet skills to support rate reviews and contract comparisons.

This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, scanners, filing cabinets, and fax machines.

The physical demands…