Credentialing & Contracting Analyst

We want you to join our team! We need deeply compassionate, committed, and highly talented staff.  The Woods organization is guided by their mission to support children and adults with disabilities or challenges to achieve their highest potential and independence through innovative and individualized approaches that promote learning and personal fulfillment.

Benefits

• Medical, Dental, and Vision Insurance
• Life and Disability Insurance
• PTO - Paid time off
• On-site medical center
• 403b retirement plan
• Continuing education programs
• Tuition-assisted program
• Career growth opportunities

Salary: $60000 to $65000 / Annually - depending on education / experience

Location: On-Site/In-Person in Yardley, PA

Job Summary:

The Contracts and Credentialing Administrator is responsible for maintaining contracts and provider profiles in all applicable systems as well as submitting all credentialing and re-credentialing applications for his/her assigned WSOC portfolio.  S/heis responsible for managing payer contracts and the credentialing and re-credentialing of facilities, licensed clinicians and prescribers. This role is integral to supporting the revenue cycle by ensuring that all credentialing and contracting requirements are fulfilled.  The Contracts and Credentialing Administrator will report directly to two individuals, the VP of Medical Billing and VP of Administration. The Contracts and Credentialing Administrator must be must be extremely organized and detail oriented.

• Manage and maintain the credentialing, provider application, and re-credentialing process for all licensed clinicians and prescribers within mental health outpatient, substance use outpatient, and intensive outpatient programs. Coordinate with HR who initializes new hires.
• Update and maintain accurate provider profiles in CAQH and other credentialing
• Submit credentialing applications and monitor progress with MCOs, commercial insurance providers, and other entities
• Reviews and resolves credentialing issues and contacts insurance carriers to verify/validate requirements to ensure accuracy and avoid potential denial.
• Validates all necessary licenses and codes to ensure they are valid for scheduled services.
• Provides timely updates to each provider’s file according to the schedule published by CMS.
• Completes re-credentialing applications for Governmental payers and Commercial Payers, as necessary.
• Ensure records of provider credentials, including NPI numbers, DEA registrations, Medicaid numbers, and licensure, are accurate and current.
• Collaborate with managed care organizations and insurance providers to secure and sustain network
• Address payer-specific issues that may delay reimbursement, such as credentialing lapses or authorization
• Regularly review payer policies and communicate updates to minimize revenue
• Monitor revenue cycle metrics tied to credentialing and provide actionable insights for improvement.
• Ensure processes adhere to state and federal regulations, including New Jersey Medicaid
• Conduct regular audits of provider profiles and payer authorizations for accuracy and
• Prepare and present metrics on credentialing and authorization activities to agency
• Support the contracting process to meet payer compliance
• Monitor contract renewals and address any changes or concerns from
• Maintains strict confidentiality on all client records and business-related records, as required under HIPAA guidelines.
• Other duties as assigned.

• Bachelor’s degree in business or a related field of study
• Highly proficient in MS Excel
• Proven ability to pick up on systems and document processes
• Ability to self-manage, motivate and to not hesitate to ask for assistance
• Demonstrated success in working in as a member of a team
• Strong organizational skills with attention to detail
• Ability to multi-task, problem solve and meet deadlines

About Woods Services

Woods Services is a Pennsylvania and New Jersey-based non-profit population health network and advocacy organization that along with its six affiliate organizations provides life-long innovative, comprehensive, and integrated health, education, housing, workforce, behavioral health, and case management services to more than 22,000 children and adults in the intellectual and developmental disability, child welfare, behavioral and brain trauma public health sectors who have complex and intensive medical and behavioral healthcare needs.

Our Langhorne campus is home to 550 residents and provides outpatient and day programs.