Contracts & Credentialing Paralegal

We're Hiring: Contracts & Credentialing Paralegal
Location: Cherry Hill
Employment Type: Exempt, Full-Time 
Department: Revenue Cycle

Salary Range: $69,000-$75,000

We are seeking an experienced and detail-oriented Contracts & Credentialing Paralegal. This position supports Bancroft, which is a human services organization serving children, adults with disabilities and individuals with behavioral health needs.  In this role, you are responsible for managing payer and provider enrollment and contracts requirements specific to government and community based funding sources.  You will oversee all payor contracting and enrollment, including but not limited to: managed care, Medicaid, Medicare, insurance carriers, school districts and private payors.  

About Bancroft:

For over 140 years, Bancroft has been making a difference in the lives of many. The organization is well known for helping people with disabilities achieve fulfilling lives while improving their function, activity and participation in society. Bancroft’s reputation for excellence is based on its commitment to providing a spectrum of individualized services, treating each person with respect and dignity, and providing services in an encouraging and supportive environment.

Contracting:
Prepares documentation for all payor applications and contracts, including, but not limited to: commercial payor initial and re-credentialing applications, annual government contract renewals (both State and Federal), Medicaid applications and revalidations, MLTSS, other State payors, including, but not limited to, NJ DDD, NJ DHS, NJ CSOC, PA DDD, PA DHS, PA Medicaid, DE DDD, IL DDD, school districts, private pay
Maintains file of required reference documents and obtains updated versions from source departments as needed; protects confidentiality of same
Maintains inventory of all contracts and fee agreements; updates and manages payor contracts in Contract Lifecycle Management (“CLM”) database in Workday
Prepares/maintains/updates contract summaries
Maintains contracting calendar, scheduling renewals, re-contracting, etc.

Prepares contract summaries with key terms, etc., for presentation to and review by senior leadership for use for new and renewal contracts
Maintains record of all organizational Medicaid provider numbers and NPI numbers
Prepares and revalidates new group home applications, including NPI numbers
Reports diversity data quarterly or more frequently, if required, to payors and governmental entities
Other duties as assigned

Credentialing:
Leads organizational and individual provider credentialing to ensure participation, including, but not limited to: Medicare, Medicaid, managed care insurance providers
Establish CAQH accounts for onboarding clinical providers and complete all CAQH applications
Maintain database of all credentialed providers with relevant, supporting documentation
Research and resolve any credentialing issues; manage deactivation of provider numbers
Maintain and verify demographic information

Privileging:
Leads the process for practitioner applications, including accompanying documents, to ensure applicant eligibility
Processes requests for privileges, ensuring compliance.
Prepares credential files for presentation to Clinical Executive Group
Monitors the initial, reappointment and expiration process for all employed clinical providers, ensuring compliance with regulatory bodies

Education & Experience:

• Paralegal certificate or Associates in Paralegal Studies required, Bachelor’s degree preferred;
• at least 3+ years of experience directly related to a hospital, physician group, managed care or outpatient practice credentialing. Preference will be given to: National Association Medical Staff Services (NAMSS) certification as a Certified Medical Services Manager (CPMSMS) or Certified Provider Credentials Specialist (CPCS).

Special Skills:
Demonstrated ability to effectively communicate both written and verbally required. Ability to think and work independently, meet deadlines and ensure that assigned projects are completed in a timely and efficient manner. Effective interpersonal skills. Working knowledge of Microsoft Office suite. Valid driver’s license required in incumbent’s name

Bancroft stands strong against racism and hate of all kinds and supports actions leading to respect, equality, fairness and peace. We advocate for and embrace an inclusive and just world. One world. For everyone. We work with heart, respect and collaboration. We are communicators, listeners, problem solvers, partners and collaborators. Bring your authentic self to our team.  

Bancroft is an Equal Opportunity Employer, and supports diversity, equity and inclusion in its hiring and employment practices, so that every team member can feel a true sense of belonging, and maximize their unique potential.  To this end, all applicants will receive consideration for employment without regard to age, race, color, religion, sex, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, veteran status or any other characteristic protected by law. 

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