Contracts Medical Specialist

Job Title:

Contracts Specialist

Job Description
The Contracts Specialist oversees payor contract data, streamlines provider enrollment, and maintains regulatory compliance across all health plans. This role serves as a critical link between contracting, credentialing, billing, and operational teams to support seamless revenue cycle management, prevent reimbursement disruptions, and ensure provider directory accuracy. By effectively bridging contracting and credentialing execution, the Contracts Specialist helps ensure providers are in-network without delay, reduces claim rejections, and supports the organization’s overall financial and operational performance.

Responsibilities

• Oversee and maintain accurate payor contract data across all health plans to support consistent and compliant operations.
• Streamline and coordinate provider enrollment processes to ensure timely in-network status and minimize delays in reimbursement.
• Act as a primary liaison between contracting, credentialing, billing, and operational teams to promote clear communication and alignment.
• Support regulatory compliance efforts by ensuring contracts, enrollment documentation, and related data meet applicable standards and guidelines.
• Contribute to seamless revenue cycle management by identifying and addressing issues that could lead to claim rejections or reimbursement disruptions.
• Monitor and help maintain accurate provider directory information to ensure up-to-date and reliable provider listings.
• Provide administrative support related to contracts administration, including organizing documents, tracking contract statuses, and updating systems.
• Assist with contracts management and procurement-related tasks, ensuring terms and conditions are properly documented and communicated.
• Engage in contract negotiation activities as needed, supporting the review and clarification of contract terms with payors and related stakeholders.
• Deliver responsive customer service to internal and external stakeholders, addressing questions and resolving issues related to contracts and credentialing.
• Collaborate with credentialing teams to ensure providers meet all requirements and that credentialing activities align with contract obligations.
• Utilize standard office and computer equipment to enter, update, and manage data related to contracts, enrollment, and credentialing.

• 2+ years of hands‑on experience in healthcare payor contracting, provider enrollment, or credentialing.
• Proficiency in contracts administration and contracts management within a healthcare environment.
• Experience supporting procurement activities related to payor contracts or provider agreements.
• Demonstrated ability to participate in contract negotiation and interpret contract terms.
• Strong customer service skills with the ability to communicate effectively with internal and external stakeholders.
• Experience providing administrative support, including document organization and data entry.
• Familiarity with credentialing processes and requirements for healthcare providers.
• Education:
  
  Associate or Bachelor’s degree in Healthcare Administration, Business, or a related field preferred, with equivalent practical experience considered.
• Ability to work accurately with contract data and maintain attention to detail in a regulatory environment.
• Comfort using computers and standard office software to manage and track contract and enrollment information.

• Certified Professional Credentialing Specialist (CPCS) or Certified Provider Credentialing Specialist credential is a strong plus.
• Experience working with multiple health plans and payors is beneficial.
• Ability to collaborate effectively across contracting, credentialing, billing, and operational…