Credentialing and Contract Manager

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    "url": "https://recruiting.paylocity.com/recruiting/jobs/Details/3832545/BestCare-Treatment-Services-Inc/Credentialing-and-Contract-Manager",
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    "description_html": "<p><strong>Join Our Team as a Contract &amp; Credentialing Manager at BestCare!</strong><br>Are you passionate about ensuring compliance and building efficient systems that support quality care? BestCare is seeking a Contract &amp; Credentialing Manager to oversee the full lifecycle of contract management, provider and facility credentialing, and third-party payer enrollment. In this pivotal role, you’ll collaborate across departments—including Finance, Operations, HR, and Leadership—to maintain a compliant infrastructure that supports revenue optimization and audit readiness. As the primary point of contact for funders, credentialing entities, and insurance plans, you’ll help ensure accurate documentation and consistent revenue flow while advancing our mission: <strong>to advocate and provide compassionate care in the treatment and prevention of addictions and mental illness</strong>.</p><p><br></p><p><strong>JOB SUMMARY: </strong>&nbsp;The Contract &amp; Credentialing Manager oversees the organization’s full lifecycle of contract management, provider &amp; facility credentialing, and third-party payer enrollment processes. This role ensures compliance with federal, state, payer, and &nbsp;&nbsp;accreditation requirements while supporting revenue optimization through accurate and timely provider enrollment and maintenance with all contracted insurers. Working cross-functionally with Finance, Operations, Human Resources, Leadership, and external partners, this position ensures BestCare maintains a compliant, efficient infrastructure for contracts, grants, credentialing, and payer enrollment. The role serves as the primary point of contact for funders, credentialing entities, and insurance or third-party payer plans, ensuring accurate documentation, audit readiness, and consistent revenue flow through maintaining active provider participation status.</p><p><br></p><p><strong>ESSENTIAL FUNCTIONS:</strong></p><p><strong>Contract, Grant, and Vendor Oversight:</strong></p><ul><li>Manages a diverse portfolio of federal, state, local, and private contracts and grants, ensuring compliance with award terms, deliverables, reporting deadlines, and regulatory requirements;</li><li>Coordinates contract review, negotiation, renewal, and execution processes across all departments and sites;</li><li>Ensures any and all credentialing and enrollment requirements of contracts are accurate, timely, and aligned with each respective contract;</li><li>Ensures contract language aligns with HIPAA, Medicaid, 42 CFR, and healthcare compliance standards;</li><li>Maintains centralized repositories for contracts, grants, amendments, reporting, and historical documentation;</li><li>Serves as primary liaison to funders and subcontractors for contract terms, compliance expectations, and reporting requirements;</li><li>Leads internal contract audits, monitors risk, and ensures audit-ready documentation;</li><li>Supports multi-year funding projections, renewal strategies, and alignment with organizational growth priorities.</li></ul><p><strong>Credentialing:</strong></p><ul><li>Ensures complete and accurate initial and re-credentialing of all licensed providers, volunteers, contractors, and temporary clinical staff;</li><li>Ensures credentialing processes comply with internal policy, payer requirements, and regulatory standards;</li><li>Coordinates collection, primary source verification, and maintenance of licensure, DEA, malpractice coverage, certifications, education, and references;</li><li>Maintains credentialing files and documentation in EHR and dedicated credentialing software and ensures data accuracy, auditing, reporting, and system maintenance;</li><li>Provides high-level process support to ensure timely completion of credentialing requirements and expiring documents.</li></ul><p><strong>Insurance Provider Enrollment &amp; Revenue Enablement:</strong></p><ul><li>Initiates, manages, and maintains enrollments for all providers with Medicaid, Medicare, and other third-party and commercial payers;</li><li>Ensures accurate provider status, directory listings, site locations, and effective dates to prevent revenue disruption;</li><li>Partners with payer representatives and internal billing teams to resolve barriers to enrollment, claim denials, or contract discrepancies;</li><li>Supports development and coordination of provider employment agreements as they relate to enrollment or credentialing requirements.</li></ul><p><strong>Compliance, Monitoring and Reporting:</strong></p><ul><li>Tracks and audits credentialing, contracting, and compliance requirements across all sites;</li><li>Conducts Office of Inspector General (OIG) monthly exclusions review for all staff;</li><li>Partners with HR to track CME completion, license renewals, and credential expirations;</li><li>Ensures all credentialing, contracting, and grant documentation meets internal, payer, and regulatory standards;</li><li>Prepares compliance and performance reports for executive leadership;</li><li>Supports organizational audits, corrective action plans, and continuous improvement initiatives.</li></ul><p><strong>Cross-Department Collaboration and Capacity Building:</strong></p><ul><li>Works closely with HR, Operations, Finance, Clinical Leadership, and Onboarding teams to coordinate and ensure provider readiness;</li><li>Trains staff on credentialing, enrollment workflows, contract compliance requirements, and documentation standards;</li><li>Communicates process updates, timelines, and requirements to providers and supervisors;</li><li>Provides dotted-line mentorship or support to staff engaged in grants, data management, or compliance functions.</li><li><strong>Systems, Documentation and Administrative Support:</strong></li><li>Develops and maintains tracking systems, dashboards, and templates for credentialing, contracting, and compliance monitoring;</li><li>Produces internal communications, summary reports, and process documents to support organizational awareness and compliance;</li><li>Coordinates agendas, meeting logistics, and documentation as needed for contract or credentialing committees.</li><li>Other related duties as assigned</li></ul><p><strong>ORGANIZATIONAL RESPONSIBILITIES:</strong></p><ul><li>Models BestCare’s mission, vision, and values, promoting integrity, compassion, and collaboration;</li><li>Supports the organization’s commitment to equity &nbsp;&nbsp;and inclusion, fostering an environment of cultural awareness &nbsp;&nbsp;and respect for all individuals;</li><li>Aligns department goals with organizational strategic initiatives;</li><li>Complies with &nbsp;&nbsp;Code of Conduct, Business Ethics, Employee Handbook, and all relevant policies and OARs;</li><li>Maintains professionalism, confidentiality, and compliance with HIPAA, 42 CFR, and Oregon statutes;</li><li>Attends required meetings, completes required trainings, and ensures certifications and licenses remain current;</li><li>Works independently and collaboratively as a positive member of the BestCare team;</li><li>Performs other organizational duties as assigned.</li></ul><p><br></p><p><strong>REQUIRED COMPETENCIES: </strong>Must have demonstrated competency or ability to attain competency for each of the following within a reasonable period:&nbsp;</p><ul><li>Proficiency and experience with credentialing and enrollment software systems such as MD Staff, CAQH ProView, Availity, OneHealthPort, and other payer portals used for enrollment, revalidation, and directory maintenance.</li><li>High proficiency &nbsp;&nbsp;in MS Office 365 (Word, Excel, Outlook), databases, virtual meeting &nbsp;&nbsp;platforms, internet, and ability to learn new or updated software;</li><li>Strong interpersonal and customer service skills;</li><li>Strong communication skills (oral and written);</li><li>Strong organizational skills and attention to detail, accuracy, and follow-through;</li><li>Excellent time management skills with a proven ability to meet deadlines;</li><li>Critical thinking skills;</li><li>Ability to maintain strict confidence as required by HIPAA, 42 CFR, and Oregon Statutes;</li><li>Ability to build and maintain positive relationships;</li><li>Ability to function well and use good judgment in a high-paced and at times stressful environment;</li><li>Ability to manage conflict resolution and anger/fear/hostility/violence of others appropriately and effectively;</li><li>Ability to work effectively and respectfully in a diverse, multi-cultural environment;</li><li>Ability to work independently as well as participate as a positive, collaborative team member.</li></ul><p><br></p>",
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      "description": "<p>Description</p><p><strong>Join Our Team as a Contract & Credentialing Manager at BestCare!</strong><br/>Are you passionate about ensuring compliance and building efficient systems that support quality care? BestCare is seeking a Contract & Credentialing Manager to oversee the full lifecycle of contract management, provider and facility credentialing, and third-party payer enrollment. In this pivotal role, you’ll collaborate across departments—including Finance, Operations, HR, and Leadership—to maintain a compliant infrastructure that supports revenue optimization and audit readiness. As the primary point of contact for funders, credentialing entities, and insurance plans, you’ll help ensure accurate documentation and consistent revenue flow while advancing our mission: <strong>to advocate and provide compassionate care in the treatment and prevention of addictions and mental illness</strong>.</p><p><br/></p><p><strong>JOB SUMMARY: </strong> The Contract & Credentialing Manager oversees the organization’s full lifecycle of contract management, provider & facility credentialing, and third-party payer enrollment processes. This role ensures compliance with federal, state, payer, and   accreditation requirements while supporting revenue optimization through accurate and timely provider enrollment and maintenance with all contracted insurers. Working cross-functionally with Finance, Operations, Human Resources, Leadership, and external partners, this position ensures BestCare maintains a compliant, efficient infrastructure for contracts, grants, credentialing, and payer enrollment. The role serves as the primary point of contact for funders, credentialing entities, and insurance or third-party payer plans, ensuring accurate documentation, audit readiness, and consistent revenue flow through maintaining active provider participation status.</p><p><br/></p><p><strong>ESSENTIAL FUNCTIONS:</strong></p><p><strong>Contract, Grant, and Vendor Oversight:</strong></p><ul><li>Manages a diverse portfolio of federal, state, local, and private contracts and grants, ensuring compliance with award terms, deliverables, reporting deadlines, and regulatory requirements;</li><li>Coordinates contract review, negotiation, renewal, and execution processes across all departments and sites;</li><li>Ensures any and all credentialing and enrollment requirements of contracts are accurate, timely, and aligned with each respective contract;</li><li>Ensures contract language aligns with HIPAA, Medicaid, 42 CFR, and healthcare compliance standards;</li><li>Maintains centralized repositories for contracts, grants, amendments, reporting, and historical documentation;</li><li>Serves as primary liaison to funders and subcontractors for contract terms, compliance expectations, and reporting requirements;</li><li>Leads internal contract audits, monitors risk, and ensures audit-ready documentation;</li><li>Supports multi-year funding projections, renewal strategies, and alignment with organizational growth priorities.</li></ul><p><strong>Credentialing:</strong></p><ul><li>Ensures complete and accurate initial and re-credentialing of all licensed providers, volunteers, contractors, and temporary clinical staff;</li><li>Ensures credentialing processes comply with internal policy, payer requirements, and regulatory standards;</li><li>Coordinates collection, primary source verification, and maintenance of licensure, DEA, malpractice coverage, certifications, education, and references;</li><li>Maintains credentialing files and documentation in EHR and dedicated credentialing software and ensures data accuracy, auditing, reporting, and system maintenance;</li><li>Provides high-level process support to ensure timely completion of credentialing requirements and expiring documents.</li></ul><p><strong>Insurance Provider Enrollment & Revenue Enablement:</strong></p><ul><li>Initiates, manages, and maintains enrollments for all providers with Medicaid, Medicare, and other third-party and commercial payers;</li><li>Ensures accurate provider status, directory listings, site locations, and effective dates to prevent revenue disruption;</li><li>Partners with payer representatives and internal billing teams to resolve barriers to enrollment, claim denials, or contract discrepancies;</li><li>Supports development and coordination of provider employment agreements as they relate to enrollment or credentialing requirements.</li></ul><p><strong>Compliance, Monitoring and Reporting:</strong></p><ul><li>Tracks and audits credentialing, contracting, and compliance requirements across all sites;</li><li>Conducts Office of Inspector General (OIG) monthly exclusions review for all staff;</li><li>Partners with HR to track CME completion, license renewals, and credential expirations;</li><li>Ensures all credentialing, contracting, and grant documentation meets internal, payer, and regulatory standards;</li><li>Prepares compliance and performance reports for executive leadership;</li><li>Supports organizational audits, corrective action plans, and continuous improvement initiatives.</li></ul><p><strong>Cross-Department Collaboration and Capacity Building:</strong></p><ul><li>Works closely with HR, Operations, Finance, Clinical Leadership, and Onboarding teams to coordinate and ensure provider readiness;</li><li>Trains staff on credentialing, enrollment workflows, contract compliance requirements, and documentation standards;</li><li>Communicates process updates, timelines, and requirements to providers and supervisors;</li><li>Provides dotted-line mentorship or support to staff engaged in grants, data management, or compliance functions.</li><li><strong>Systems, Documentation and Administrative Support:</strong></li><li>Develops and maintains tracking systems, dashboards, and templates for credentialing, contracting, and compliance monitoring;</li><li>Produces internal communications, summary reports, and process documents to support organizational awareness and compliance;</li><li>Coordinates agendas, meeting logistics, and documentation as needed for contract or credentialing committees.</li><li>Other related duties as assigned</li></ul><p><strong>ORGANIZATIONAL RESPONSIBILITIES:</strong></p><ul><li>Models BestCare’s mission, vision, and values, promoting integrity, compassion, and collaboration;</li><li>Supports the organization’s commitment to equity   and inclusion, fostering an environment of cultural awareness   and respect for all individuals;</li><li>Aligns department goals with organizational strategic initiatives;</li><li>Complies with   Code of Conduct, Business Ethics, Employee Handbook, and all relevant policies and OARs;</li><li>Maintains professionalism, confidentiality, and compliance with HIPAA, 42 CFR, and Oregon statutes;</li><li>Attends required meetings, completes required trainings, and ensures certifications and licenses remain current;</li><li>Works independently and collaboratively as a positive member of the BestCare team;</li><li>Performs other organizational duties as assigned.</li></ul><p><br/></p><p><strong>REQUIRED COMPETENCIES: </strong>Must have demonstrated competency or ability to attain competency for each of the following within a reasonable period: </p><ul><li>Proficiency and experience with credentialing and enrollment software systems such as MD Staff, CAQH ProView, Availity, OneHealthPort, and other payer portals used for enrollment, revalidation, and directory maintenance.</li><li>High proficiency   in MS Office 365 (Word, Excel, Outlook), databases, virtual meeting   platforms, internet, and ability to learn new or updated software;</li><li>Strong interpersonal and customer service skills;</li><li>Strong communication skills (oral and written);</li><li>Strong organizational skills and attention to detail, accuracy, and follow-through;</li><li>Excellent time management skills with a proven ability to meet deadlines;</li><li>Critical thinking skills;</li><li>Ability to maintain strict confidence as required by HIPAA, 42 CFR, and Oregon Statutes;</li><li>Ability to build and maintain positive relationships;</li><li>Ability to function well and use good judgment in a high-paced and at times stressful environment;</li><li>Ability to manage conflict resolution and anger/fear/hostility/violence of others appropriately and effectively;</li><li>Ability to work effectively and respectfully in a diverse, multi-cultural environment;</li><li>Ability to work independently as well as participate as a positive, collaborative team member.</li></ul><p><br/></p><p>Requirements</p><p><strong>QUALIFICATIONS:</strong></p><p><strong>EDUCATION AND/OR EXPERIENCE:</strong></p><ul><li>Bachelor’s degree in business, Healthcare Administration, Public Administration, or related field preferred</li><li>Minimum 3–5 years of experience in credentialing, provider enrollment, contract management, grants administration, or related areas</li><li>Equivalent combinations of education and experience may be considered</li></ul><p><strong>LICENSES AND CERTIFICATIONS:</strong></p><ul><li>Must maintain a valid Oregon Driver License or ability to obtain one upon hire, and be insurable under the organization’s auto liability coverage policy (minimum 21 years of age and with no Type A violations in the past 3 years, or three (3) or more Type B violations) and must have a reliable vehicle with adequate insurance to travel as needed</li></ul><p><strong>PREFERRED:</strong></p><ul><li>Certified Provider Credentialing Specialist (CPCS) desirable</li><li>Professional certification or training in grants/contract management (e.g., GPC, CGMS) preferred</li></ul>",
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