Contracting Specialist

DescriptionDescription

Summary/Objective

The Contracting Specialist will be a member of the NorthShore Health Centers team and will be responsible for timely processing and completion of initial/re-credentialing insurance contracts for all NorthShore providers and locations.

Essential Functions

Complete provider initial and re-credentialing applications, provider demographic update forms, and letters for Medicare, Medicaid, managed care plans, and commercial insurances.

Maintain and remain in compliance with payer and product directory updates monthly and quarterly through portals such as Availity, LexisNexis, Better Doctor, and other validation tools.

Utilize and navigate Medicaid, NPPES, CAQH and additional sites/portals for providers and NorthShore locations as they are needed.

Construct new provider CAQH profiles, update current CAQH applications, and attest the CAQH profiles quarterly for all providers.

Create new NorthShore location NPIs and enroll the new locations in Medicare, Medicaid, managed care plans, and commercial insurances.

Communicate with the appropriate NorthShore staff on the status of insurance contracts as needed.

Performs other duties as identified or assigned.

*These essential functions are a summary of the primary duties and responsibilities of the position and are not intended to be a comprehensive listing of all duties and responsibilities. The position will include other duties as assigned, and duties are subject to change at management's discretion.

Competencies

Planning and strategic foresight

Responsible Decision Making

Integrity and accountability

Innovation and creativity

Adaptive and flexible

Leadership, teamwork, and conflict resolution

Professionalism and work ethic

Empathy

Work Environment

Work is performed in an office environment. Involves frequent personal and telephone contact with patients, physicians, and other healthcare personnel. Work may be stressful at times. Interaction with others is constant and interruptive.

Travel

Travel within Northshore locations will be rare for this position. Travel outside of Northshore locations will be rare for this position.

Required Role Qualifications

Bachelor’s Degree in Healthcare Administration, Business, or related studies

Preferred Role Qualifications

Master’s Degree in Healthcare Administration, Business, or related studies

Two years of experience working within a healthcare setting

Required Skills

Ability to analyze situations and solve problems at strategic and tactical levels

Excellent interpersonal and customer service skills

Ability to comprehend, interpret, and apply the appropriate sections of applicable laws, guidelines, regulations, ordinances, and policies

Ability to acquire a thorough understanding of the organization's hierarchy, jobs, qualifications, compensation practices, and the administrative practices related to those factors

Practiced at organization and planning

Employ Critical thinking and problem solving

Maintains composure and operates with emotional intelligence

Ethical reasoning and decision-making

Strong attention to detail

Receptive and responsive to feedback

Excellent verbal and written communication skills

Time management, prioritization, and sense of urgency

Proficient with Microsoft Office Suite or related software