Job Description
Job Description
Description :
Wellness Equity Alliance (WEA) is a national public health organization comprised of a multidisciplinary team of population and public health experts with backgrounds in infectious disease, public health, emergency medicine, primary care, cardiology, pediatrics, psychiatry, community health work (CHW), nursing and advanced practice pharmacy. We work nearly exclusively with underrepresented communities, fundamentally addressing health-care disparities and the social determinants of health (SDoH), prioritizing the following :
- People experiencing homelessness
- Indigenous communities
- Immigrant communities
- Rural communities
- BIPoC communities
- LGBTQIA communities
- Justice-impacted communities
The WEA team is diverse, inclusive, and nimble with a partnership model that is collaborative to provide timely care using equity-based strategies for individuals and marginalized communities.
Purpose of the position
The Contracting & Credentialing Specialist is responsible for managing the enrollment, credentialing, and re-credentialing processes for Wellness Equity Alliance, WEA CA PC and Wellness Equity Institute and other WEA entities and providers. This role involves the best available contracted rates with payors (CMS, MCOs, IPAs, etc) expeditiously and ensuring compliance with legal and regulatory requirements. The specialist will maintain accurate records, proactively keep senior leadership informed regarding status of contracts, respond to inquiries in a timely manner, and manage the credentialing process for all clinical and non-clinical staff.
Requirements : Key Responsibilities
Responsible for the organizations’ contracting and credentialing with Medicare, state Medicaid programs and respective managed care plans and independent physician associations (IPAs). This will include the project management of tactical approaches on the most expeditious process to have both organizations contracted as well as their providers credentialed.Prepare, submit, and maintain enrollment, credentialing, and re-credentialing documentation for all medical providers and other service providers in all participating state programs.Facilitate provider enrollment with commercial insurance payers, Medi-Cal, Medicare, and other programs.Work collaboratively with People and Culture and Clinical teams to facilitate expeditious onboarding of all new clinical and service providers, including :collection of all relevant materials to begin the credentialing process
coordination of all relevant materials in order to ensure the internal privileging of all providersMedical Malpractice information is collected and submitted to our insurance vendors. Facilitate expeditious onboarding of all new clinical and service providers, including : collection ofVerify education, licensure, board certification, and malpractice coverage for all clinical staff.Proactively identify and resolve issues with provider enrollment and payer contracts to avoid service interruptions.Maintain an organized tracking and filing system that allows others in the organization to review all applications, approval letters, denial letters, etc.Collaborate with Operations and Clinical team members to ensure all providers are aware of billing codes and documentation requirements and the process for submission for each payor.Develop and implement coding / billing strategy and process to monitor and optimize reimbursement revenues, including ongoing training of providers through QI program.Analyze potential payer networks to assess reimbursement rates, contract terms, and opportunities for partnership.Develop and maintain a database of target MCOs and IPAs, including key decision-makers and contact information.Establish, maintain and nurture relationships with key stakeholders at MCOs and IPAs, including network managers, provider relations representatives, and contracting officers.Review payor contracts to ensure they align with WEA’s goals, compliance standards, and legal requirements.Draft, review, and submit comprehensive LOIs and applications to Medicare, Medicaid, MCOs, IPAs, and other healthcare organizations, for each WEA entity, ensuring alignment with their requirements and our strategic objectivesCompile and maintain files of necessary supporting documentation, including organizational qualifications, program descriptions, and compliance certifications.Maintain an organized system for tracking contract renewals, amendments, and expirations.Stay up to date on state, federal, and payer credentialing requirements, including Medi-Cal and Medicare regulations.Ensure compliance with accreditation standards and maintain required documentation for audits.Address and resolve compliance issues related to contracting and credentialing promptly.Proactively ensure CDO, CEO and CMO are updated as to the status of all contracting and credentialing tasks.Generate reports on credentialing status, contract milestones, and payer relations for leadership and stakeholders.Coordinate all hospital contracting.Qualifications
Bachelor’s degree in Public Health, Business Administration, Nonprofit Management, or a related fieldMaster’s degree preferred).3-5 years of experience in project management, preferably in public health, healthcare, or nonprofit settings.Essential skills
Advanced proficiency with CMS, MCO, IPA, and other payer submission processes.Solution-oriented with strong problem-solving capabilities.Strong organizational and time management skills with the ability to manage multiple projects simultaneously.Strong analytical skills to interpret data, evaluate payer contracts, and identify opportunities for growth.In-depth knowledge of Medi-Cal, Medicare, and other payer-specific regulations.Exceptional communication skills with strong verbal and written communication to effectively engage with stakeholders and represent WEA.Preferred Skills
Knowledge of public health, social services, and health equity principles.Understanding of healthcare delivery models, including Enhanced Care Management (ECM) and Community Supports programs.Skilled in collaboration across multidisciplinary teams to ensure alignment and efficiency in processes.Familiarity with systems like CAQH ProView, Symplr, or similar credentialing and provider enrollment platforms to streamline workflows and ensure compliance.Knowledge of process improvement methodologies, to identify inefficiencies in contracting and credentialing workflows and implement effective solutions.
