Job Description

Job Description

Job Description

SUMMARY:    

Dual Roles:  
1. Coordinates physician and allied health professional credentialing and enrollment 
activities with Medicare, hospitals, health plans, and other regulatory organizations. This 
role prepares and submits credentialing applications, maintains credentialing records, and  
supports physicians’ medical and DEA license renewals, CME tracking, and re
credentialing as needed. 

2. First-line review for all contracts in support of Executive Administrator (J.D.) including 
maintaining terms and conditions of all contracts in a contract management program.

Primary Responsibilities 
1. Prepares and submits initial/on-boarding credentialing and re-credentialing enrollment applications 
for physicians and allied health professionals with hospitals, health plans, Medicare, and 
commercial insurance carriers. 
2. Ensures the Medicare enrollment status for each physician and the entity is complete, accurate, 
and up-to-date at all times.  Responds timely to any and all correspondence received from 
Medicare.  
3. Submits new provider information and updates to the National Provider Identifier (NPI) registry and 
Council for Affordable Quality Healthcare (CAQH). 
4. Maintains credentialing files for physicians and allied health professionals including licenses, CME, 
certifications and regulatory documentation. Monitors expiration dates for provider licenses, Drug 
Enforcement Administration (DEA) registrations, professional liability insurance, and specialty 
board certifications. Prepares and submits renewal applications and documentation prior to 
expiration deadlines. 
5. Maintains complete, accurate, and up-to-date documentation of provider enrollment records with 
Medicare and managed care entities. 
6. Assists all department managers/directors by providing first-line review of all contracts in a manner 
that is consistent with the entity’s standards and Executive Administrator’s expectations.  Coaches 
managers on negotiating tips for requested changes on contracts.  Such contracts include, but are 
not limited to: 
i. Employment agreements; 
iil Equipment and building maintenance; 
III. Equipment and building leases; 
iv. Bank loans and mortgage loans; 
v. Software support services; 
vi. Contracts with payors and managed care organizations; 
vii. Supplier contracts; and 
viii. Service agreements 

7. Assists in identifying and handling start-up implementation for a contract management system.  
8. Maintains all data in contract management system and follows-up as needed on tracking and 
maintaining finalized, fully executed contracts.  Enters all terms and conditions in contract 
management system including, but not limited to, terms of contract, renewal terms, termination 
terms and notice periods/process, price escalation agreements, and insurance requirements 
including current proof of insurance. 
9. Performs all other duties as assigned.

Education and Experience 
• Associate degree in Paralegal Studies or related field required; Bachelor’s degree in Paralegal 
Studies preferred. 
• ABA-approved paralegal certificate required. 
• Experience with physician credentialing, Medicare enrollment, and healthcare administration 
required. 
• Experience with contract review, management, and negotiation required.  

Required Skills and Abilities 
• Strong organizational and time management skills. 
• Strong attention to detail  
• Effective written and verbal communication skills. 
• Ability to maintain confidential and sensitive information. 
• Ability to coordinate multiple tasks and deadlines simultaneously. 
• Strong customer service skills when interacting with physicians, management team, and 
administration. 
• Professional interpersonal skills with the ability to interact effectively with leadership, 
physicians, and peers. 
• Proficiency in Microsoft Office (Word, Excel, Outlook, and PowerPoint). 

Physical Requirements 
• Ability to sit for extended periods while working at a computer workstation; 
• Frequent use of hands and fingers for typing, data entry, and phone use; 
• Ability to speak clearly and hear well enough to communicate by phone and in person; 
• Occasional standing, walking, bending, and reaching; 
• Ability to lift and carry up to 25 pounds (files, office supplies); 
• Visual acuity to read computer screens; and 
• Ability to focus for long periods and manage high-volume, detail-oriented tasks. 

Job Tags

Contract work, Work at office

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