Provider Credentialing Contracting

GROUP HEALTH COOP- SOUTH CENTRAL WI • Madison, WI • 1h ago

JOB REQUIREMENTS: Group Health Cooperative of South Central Wisconsin.
BETTER TOGETHER Full-time- 40 hours Hybrid role - In-office training
followed by a mix of work-from-home days and office days (2-3 days on
site at the Administration Building) Candidate must live in the Madison,
WI area and be able to work on-site as needed. The Provider
Credentialing & Contracting Coordinator is responsible for supporting
provider contracting, credentialing, and administrative functions at
Group Health Cooperative of South Central Wisconsin. The primary focus
of this role is assisting in negotiating and maintaining provider
contracts, serving as the main contact for provider inquiries,
overseeing contract setup and auditing, analyzing contracts for
potential renegotiation and training providers in the use of
self-service tools for insurance administration activities. In addition
to contracting responsibilities, the specialist assists with the
credentialing and recredentialing processes and ensures compliance with
NCQA standards for Delegated Credentialing Agreements. The Provider
Contracting and Credentialing Specialist will work under the guidance of
the Chief Strategy and Business Development Officer. JOB SPECIFIC
MINIMUM QUALIFICATIONS Associate\'s or Bachelor\'s degree in business,
healthcare administration or a related field or an applicable
combination of education and work experience required. Bachelor\'s
Degree preferred. Must be able to understand contract language and
provider payment methodologies. Credentialing certificate preferred but
not required. As a condition of employment, incumbent may be required to
obtain certification within a reasonable time period. Knowledge of or
ability to learn National Committee for Quality Assurance (NCQA) and/or
Joint Commission on Health Care Organizations (JCHCO) standards
required. Knowledge of and familiarity with medical terminology
preferred. Strong interpersonal and communications skills and the
ability to work effectively with a wide range of constituencies in a
diverse community required. Ability to be culturally sensitive and to
work with diverse populations. Strong customer service skills and the
ability to maintain an excellent rapport with providers and their staff
Time management skills and flexibility to work on multiple
projects/assignments simultaneously, with ability to change focus as
business needs dictate. Willingness to assume diverse duties and
challenges Knowledge of and proven proficiency in the use of Microsoft
Office applications including Word, Outlook, Excel and PowerPoint is
required. Knowledge of and/or ability to learn and use computer based
applications/software such as... For full info follow application link.
Group Health Cooperative is an Equal Opportunity Employer and all
qualified applicants will receive consideration for employment without
regard to race, color, religion, sex, sexual orientation, gender
identity, national origin, veteran status or disability. ***
APPLICATION INSTRUCTIONS: Apply Online: ipc.us/t/CA817EA3F757475F

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