We are seeking a highly organized and experienced Credentialing, Contracting, and Claims Analyst Manager to oversee the critical functions that support our revenue cycle and provider network. This leadership role ensures compliance with payer requirements, accurate provider enrollment, efficient contract negotiation, and timely claims analysis/resolution.
Key Responsibilities:
Credentialing & Provider Enrollment:
- Oversee and manage initial and re-credentialing processes for all providers.
- Maintain up-to-date provider files in accordance with regulatory and payer standards.
- Monitor expirables (licenses, certifications, etc.) and ensure timely renewals.
Contracting:
- Negotiate payer contracts in collaboration with executive leadership.
- Review contract terms for reimbursement accuracy, term clauses, and performance benchmarks.
- Maintain an organized contract management database and ensure timely renewals and renegotiations.
Claims & Reimbursement:
- Monitor claims submission, denials, and reimbursements to identify trends and issues.
- Work with billing teams to resolve denied or underpaid claims.
- Perform root-cause analysis on high-volume denials and initiate process improvements.
Leadership & Compliance:
- Manage and support a team of credentialing and billing analysts.
- Ensure compliance with CMS, and payer-specific credentialing requirements.
- Collaborate cross-functionally with billing, finance, and operations teams.
Preferred Experience:
- Familiarity with radiology or imaging centers.
- Experience using credentialing software such as CAQH, or similar platforms.
Benefits:
- Health, dental, and vision insurance
- Paid time off and holidays
- Professional development opportunities
Job Type: Full-time
Pay: $19.08 - $22.00 per hour
Benefits:
- Dental insurance
- Employee discount
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Schedule:
- Day shift
- Monday to Friday
Work Location: In person
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