MANAGER - PAYOR CONTRACTING and CREDENTIALING

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We are currently seeking an experienced:

MANAGER OF PAYOR CONTRACTING and CREDENTIALING

JOB SUMMARY:

• Oversee administrative management of payor contracts for SNF, Home Health, and Hospice services, including Medicare Advantage, Medicaid managed care, commercial insurers, and VA Community Care Network (CCN).
• Coordinate payor contract intake, routing, tracking, renewals, and amendments in partnership with Legal, Finance, and Operations departments.
• Maintain organized contract files and monitor contract status to ensure timely renewals and ongoing compliance.
• Assist with due diligence and contracting activities for new providers, service expansions, and acquisitions under the direction of legal leadership.
• Manage initial enrollment, CHOW applications, credentialing, re-credentialing, and revalidation processes for provider entities, facilities, and clinicians.
• Ensure timely completion of:
  • CMS Medicare enrollment and revalidation (PECOS)
  • State Medicaid enrollment and re-enrollment
  • Medicare Advantage and commercial payor credentialing
  • VA credentialing and CCN participation requirements
• Monitor enrollment expirables and revalidation cycles to avoid lapses in payor participation or interruptions in payment.
• Prepare and submit accurate and complete enrollment and credentialing applications to payor portals.
• Manage the credentialing, re-credentialing, and ongoing payor enrollment of Nurse Practitioners supporting Palliative Care services across Skilled Nursing, Home Health, and Hospice settings.
• Oversee credentialing and payor participation for Nurse Practitioners serving Liberty Medicare Advantage I'SNP and C'SNP programs, ensuring compliance with plan-specific participation, delegated credentialing requirements, and network adequacy standards.
• Coordinate Nurse Practitioner enrollment and credentialing with:
  • Medicare and Medicare Advantage plans (including I'SNP and C'SNP products)
  • State Medicaid, as applicable
  • Commercial payors and delegated entities
• Ensure Nurse Practitioner credentialing files contain required licensure, certifications, malpractice coverage, collaborative or supervisory agreements (as applicable), and payor-specific documentation.
• Track Nurse Practitioner credentialing expirables, re-credentialing cycles, and payor participation status to prevent gaps in coverage or reimbursement.
• Serve as the main liaison between Legal, Clinical Leadership, and Medicare Advantage plan representatives for Nurse Practitioner credentialing matters related to Palliative, I'SNP, and C'SNP programs.
• Identify and escalate credentialing risks, denials, or participation issues affecting plan compliance, network participation, or payment.
• Ensure enrollment and credentialing activities comply with CMS Conditions of Participation, state licensure requirements, and payor standards.
• Identify and escalate contract, enrollment, or credentialing risks, denials, or deficiencies to Legal leadership.
• Support responses to payor audits, corrective action plans, and enrollment-related inquiries.
• Maintain documentation to support regulatory, legal, and payor reviews.
• Maintain tracking tools and dashboards to monitor contract status, credentialing cycles, and revalidation deadlines.
• Develop and adhere to standardized workflows, checklists, and controls for contracting and credentialing processes.
• Act as the primary point of contact for internal stakeholders regarding payor enrollment and credentialing status.
• Collaborate with Revenue Cycle and Billing teams to resolve enrollment-related payment or denial issues.
• Partner with Legal, Compliance, Finance, Revenue Cycle, and Operations teams to support organizational objectives.
• Communicate payor participation requirements to facility and agency leadership.
• Support organizational readiness for surveys, audits, and payor reviews related to enrollment and contracting.

• Bachelor's degree preferred; preferred fields include healthcare administration, business, legal studies, or a related area.
• 3-5 years of experience in healthcare payor contracting, provider enrollment, credentialing, or similar compliance roles.
• Experience in post'acute care (SNF, Home Health, and/or Hospice) is strongly preferred.
• Working knowledge of Medicare, Medicaid, Medicare Advantage, commercial payors, and VA credentialing processes.
• Familiarity with CMS enrollment and revalidation requirements (PECOS).
• Strong organizational and document management skills.
• High attention to detail and ability to manage multiple deadlines simultaneously.
• Ability to recognize compliance and contractual risks and escalate them appropriately.
• Strong written and verbal communication skills.
• Regulatory and contractual compliance
• Detail-oriented execution
• Risk awareness and escalation
• Cross-functional coordination
• Process discipline and documentation
• Timely completion of all credentialing and revalidation cycles
• No preventable lapses in payor enrollment
• Accurate and complete contract documentation
• Effective escalation of issues to Legal
• Reduced delays or denials of claims due to enrollment issues