Job Summary:The Credentialing and Contracting Specialist is responsible for ensuring that healthcare providers meet all necessary licensing, certification, and compliance requirements to participate in various insurance networks. This role involves verifying credentials, maintaining provider databases, negotiating contracts, and ensuring regulatory compliance with payer and accreditation standards.Roles and ResponsibilitiesCredentialing Duties:Collect, review, and verify healthcare provider credentials, including licenses, certifications, education, and work history.Maintain accurate and up-to-date credentialing files in compliance with regulatory bodies (e.g., CMS, NCQA, JCAHO).Submit and process provider applications for enrollment in insurance networks and monitor approval status.Track and ensure timely re-credentialing of providers to prevent lapses in participation.Communicate with providers regarding missing or expired documentation and resolve credentialing issues.Contracting Duties:Assist in negotiating provider contracts with insurance companies, hospitals, and other healthcare organizations.Prepare, review, and update contracts, fee schedules, and reimbursement terms.Maintain an organized database of contracts and ensure compliance with contract terms.Serve as a liaison between providers and payers to facilitate contract execution and resolution of disputes.Monitor contract renewals and modifications, ensuring providers remain in good standing with payers.QualificationsAny bachelors degree preferred.Minimum of 2+ years of experience in credentialing, contracting, or provider enrollment.Strong knowledge of healthcare regulations, payer requirements, and credentialing standards.Experience with credentialing software and provider enrollment systems.Excellent attention to detail and organizational skills.Strong communication and negotiation skills.Ability to manage multiple tasks and meet deadlines in a fast-paced environment.Willing to work on night shifts (US Timings)Preferred Qualifications:Experience working with commercial and government payers (Medicare, Medicaid).Knowledge of CAQH, PECOS, and other credentialing databases.Certification in healthcare credentialing (e.g., CPCS, CPMSM) is a plus