Health Insurance Credentialing & Contract Specialist

Position Summary:
The Healthcare Insurance Credentialing & Contract Specialist is responsible for submitting for new contracts, negotiating, evaluating old contracts, and managing contracts with our practice and PPO, IPA and other insurance companies as well as and physician credentialing and maintenance. This role ensures compliance with federal, state, and local regulations while optimizing terms for cost efficiency and service quality.  This role is ideal for an experienced contract specialist who is looking for additional contract work. This role is predominantly remote but will require occasional in-office meetings with management (at our main location in La Jolla).

Key Responsibilities:

• Credentialing Negotiation:
  • Conduct comprehensive verification of healthcare providers’ credentials, including education, training, licensure, board certification, and work history
  • Process initial applications and recredentialing requests within defined timelines.
  • Compliance Management:
    • Ensure adherence to federal, state, and organizational regulations, including those of accrediting bodies such as the Joint Commission or NCQA.
    • Stay updated on industry standards and changes in credentialing requirements.
  • Documentation and Recordkeeping:
    • Maintain accurate, up-to-date, and organized provider credentialing files.
    • Enter and update provider information in credentialing software systems.
      

• Contract Negotiation:
  • Develop and negotiate contracts with insurance providers,.
  • Secure favorable terms that align with organizational objectives and regulatory requirements.
• Contract Management:
  • Review and evaluate contract terms for accuracy, completeness, and compliance with legal standards.
  • Maintain a database of active contracts and ensure timely renewal or termination as needed.
  • Monitor and address any discrepancies or disputes related to contracts.
• Regulatory Compliance:
  • Stay updated on healthcare laws, policies, and regulations affecting insurance contracts.
  • Ensure all agreements adhere to HIPAA, CMS, and other applicable standards.
    

Qualifications and Skills:

• Education:
  • Bachelor’s degree in Healthcare Administration, Business, Law, or a related field.  
• Experience:
  • 3-5 years of experience in healthcare contracting, insurance negotiations, or a related field.
  • Familiarity with managed care, value-based care models, and provider networks.
• Skills:
  • Strong knowledge of healthcare regulations and compliance standards (e.g., HIPAA, ACA).
  • Excellent negotiation, analytical, and problem-solving skills.
  • Proficiency in contract management software and Microsoft Office Suite.
  • Ability to communicate complex information clearly and effectively to diverse audiences.

Key Competencies:

• Detail-oriented with the ability to manage multiple contracts simultaneously.
• Strategic thinker with the ability to align contracts with organizational goals.
• Adaptability to navigate changes in healthcare policies and market trends.

Work Environment:
This role may require occasional travel to our main La Jolla location for meetings with providers or management, but work may be performed in predominantly a remote setting. 

Equal Opportunity Employer:
La Jolla Vein & Vascular is an Equal Opportunity Employer and values diversity in the workplace. We encourage applications from all qualified candidates.