Credentialing and Contract Manager

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Full-time

The Contract & Credentialing Manager oversees the organization’s full lifecycle of contract management, provider & facility credentialing, and third‑party payer enrollment processes. This role ensures compliance with federal, state, payer, and accreditation requirements while supporting revenue optimization through accurate and timely provider enrollment and maintenance with all contracted insurers. Working cross‑functionally with Finance, Operations, Human Resources, Leadership, and external partners, the position ensures Best Care maintains a compliant, efficient infrastructure for contracts, grants, credentialing, and payer enrollment.

The manager serves as the primary point of contact for funders, credentialing entities, and insurance or third‑party payer plans, ensuring accurate documentation, audit readiness, and consistent revenue flow.

• Manages a diverse portfolio of federal, state, local, and private contracts and grants, ensuring compliance with award terms, deliverables, reporting deadlines, and regulatory requirements.
• Coordinates contract review, negotiation, renewal, and execution processes across all departments and sites.
• Ensures any and all credentialing and enrollment requirements of contracts are accurate, timely, and aligned with each respective contract.
• Ensures contract language aligns with HIPAA, Medicaid, 42 CFR, and healthcare compliance standards.
• Maintains centralized repositories for contracts, grants, amendments, reporting, and historical documentation.
• Serves as primary liaison to funders and subcontractors for contract terms, compliance expectations, and reporting requirements.
• Leads internal contract audits, monitors risk, and ensures audit‑ready documentation.
• Supports multi‑year funding projections, renewal strategies, and alignment with organizational growth priorities.

• Ensures complete and accurate initial and re‑credentialing of all licensed providers, volunteers, contractors, and temporary clinical staff.
• Ensures credentialing processes comply with internal policy, payer requirements, and regulatory standards.
• Coordinates collection, primary source verification, and maintenance of licensure, DEA, malpractice coverage, certifications, education, and references.
• Maintains credentialing files and documentation in EHR and dedicated credentialing software and ensures data accuracy, auditing, reporting, and system maintenance.
• Provides high‑level process support to ensure timely completion of credentialing requirements and expiring documents.

• Initiates, manages, and maintains enrollments for all providers with Medicaid, Medicare, and other third‑party and commercial payers.
• Ensures accurate provider status, directory listings, site locations, and effective dates to prevent revenue disruption.
• Partners with payer representatives and internal billing teams to resolve barriers to enrollment, claim denials, or contract discrepancies.
• Supports development and coordination of provider employment agreements as they relate to enrollment or credentialing requirements.

• Tracks and audits credentialing, contracting, and compliance requirements across all sites.
• Conducts Office of Inspector General (OIG) monthly exclusions review for all staff.
• Partners with HR to track CME completion, license renewals, and credential expirations.
• Ensures all credentialing, contracting, and grant documentation meets internal, payer, and regulatory standards.
• Prepares compliance and performance reports for executive leadership.
• Supports organizational audits, corrective action plans, and continuous improvement initiatives.

• Works closely with HR, Operations, Finance, Clinical Leadership, and Onboarding teams to coordinate and ensure provider readiness.
• Trains staff on credentialing, enrollment workflows, contract compliance requirements, and documentation standards.
• Communicates process updates, timelines, and requirements to…