Provider Credentialing & Contracting Coordinator

Provider Contracting And Credentialing Specialist

The Provider Contracting and Credentialing Specialist 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 electronic time and attendance systems. Ability to use the Internet to obtain information and conduct research.
• Ability to build and maintain relationships with internal and external partners.
• Excellent written and verbal communication and interpersonal skills. Ability to speak and listen in person and in virtual meetings.
• Ability to maintain patient, employee and proprietary confidentiality required. Knowledge of or ability to learn HIPAA requirements.
• Ability to pay attention to detail required.
• Ability to work comfortably and routinely as part of a team and to cooperate across organizational boundaries.
• Professional manner necessary to deal courteously and effectively with customers and external partners.
• Possession of a valid Wisconsin Driver license with a good driving record. Access to transportation and ability to travel.
• Ability to maintain patient confidentiality required. Knowledge of medical records and appropriate documentation requirements. Knowledge of HIPAA requirements.

The incumbent knows and abides by all Group Health Cooperative of South Central Wisconsin (GHC-SCW) organizational and departmental policies, sets personal standards and strives for high quality work in completing assignments, performs job duties in a timely manner, and represents the organization in a positive manner. The incumbent understands our Mission, Vision, and Common Values (stated below) and is committed to promote these values in behavior and attitude.

Our Mission Statement : We partner with members and the communities we serve to maximize health and well-being.

Our Vision : As a local, not-for-profit, member-owned Cooperative, we are the most trusted resource for lifelong health and well-being in the communities we serve.

Our Values :

GHC-SCW is committed to fostering a caring and compassionate environment while ensuring that individual differences are valued. GHC-SCW is a quality driven cooperative built on collaboration, community involvement, innovation, and belonging. It is essential that all employees, members, and patients feel secure and welcome, that the opinions and contributions of all individuals are respected and that all voices are heard.

We believe :

Group Health Cooperative of South Central Wisconsin is proud to be an equal opportunity employer. GHC-SCW considers candidates regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status.