Job Description

We are seeking a detail-oriented and experienced Credentialing & Contracting Specialist to manage and optimize the insurance relationships of our medical laboratory. This role requires close collaboration with insurance carriers and lab stakeholders to ensure seamless enrollment, contract negotiation, and ongoing credentialing. Your contributions will directly impact our operational efficiency and ensure compliance with payer standards.

Key Responsibilities

• Collaborate with insurance companies and laboratory leadership to negotiate and execute contractual agreements.
• Develop and lead strategies for payer contracting, including high-level negotiations for new and existing agreements.
• Oversee provider enrollment processes with Medicare, Medicaid, and commercial payers.
• Manage and maintain all necessary provider and facility documentation, including application submissions and regular updates to payer portals.
• Ensure timely re-credentialing and contract renewals to avoid service interruptions.
• Utilize and navigate billing systems such as CollaborateMD and various payer platforms for efficient management.
• Analyze and assist with insurance fee schedule negotiations and reimbursement structures.

Required Qualifications

• In-depth understanding of payer enrollment, healthcare credentialing systems, and compliance standards.
• Proficient with the Microsoft Office Suite, particularly Excel and Word.
• Minimum 2+ years of hands-on experience in medical laboratory credentialing (non-negotiable).
• Familiarity with practice management or billing platforms; experience with CollaborateMD is highly desirable.
• Strong skills in reporting, data analysis, and presenting credentialing insights and KPIs.
• Outstanding organizational abilities with excellent written and verbal communication.

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