Contracting Specialist

Description

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