Contracts & Credentialing Paralegal

Overview

We're Hiring: Contracts & Credentialing ParalegalLocation: Cherry HillEmployment Type: Exempt, Full-Time Department: Revenue Cycle

Salary Range: $68,994-$81,058

We are seeking an experienced and detail-oriented Contracts & Credentialing Paralegal to oversee payer contracting, enrollment, and credentialing operations. In this role, you will manage all payer relationships including managed care, Medicaid, Medicare, commercial insurance carriers, school districts, and private payers, while maintaining accurate contract records, chargemaster data, and fee schedules. You will lead and coordinate the credentialing and re-credentialing process for all employed clinical providers, ensuring compliance with accrediting bodies, regulatory agencies, and applicable statutes. This role is also responsible for maintaining the accuracy and integrity of the credentialing database and supporting the organization’s commitment to regulatory compliance and operational excellence.

About Bancroft:

For over 140 years, Bancroft has been making a difference in the lives of many. The organization is well known for helping people with disabilities achieve fulfilling lives while improving their function, activity and participation in society. Bancroft’s reputation for excellence is based on its commitment to providing a spectrum of individualized services, treating each person with respect and dignity, and providing services in an encouraging and supportive environment.

Responsibilities

Contracting:Prepares documentation for all payor applications and contracts, including, but not limited to: commercial payor initial and re-credentialing applications, annual government contract renewals (both State and Federal), Medicaid applications and revalidations, MLTSS, other State payors, including, but not limited to, NJ DDD, NJ DHS, NJ CSOC, PA DDD, PA DHS, PA Medicaid, DE DDD, IL DDD, school districts, private payMaintains file of required reference documents and obtains updated versions from source departments as needed; protects confidentiality of sameMaintains inventory of all contracts and fee agreements; updates and manages payor contracts in Contract Lifecycle Management (“CLM”) database in WorkdayPrepares/maintains/updates contract summariesMaintains contracting calendar, scheduling renewals, re-contracting, etc.

Prepares contract summaries with key terms, etc., for presentation to and review by senior leadership for use for new and renewal contractsMaintains record of all organizational Medicaid provider numbers and NPI numbersPrepares and revalidates new group home applications, including NPI numbersReports diversity data quarterly or more frequently, if required, to payors and governmental entitiesOther duties as assigned

Credentialing:Leads organizational and individual provider credentialing to ensure participation, including, but not limited to: Medicare, Medicaid, managed care insurance providersEstablish CAQH accounts for onboarding clinical providers and complete all CAQH applicationsMaintain database of all credentialed providers with relevant, supporting documentationResearch and resolve any credentialing issues; manage deactivation of provider numbersMaintain and verify demographic information

Privileging:Leads the process for practitioner applications, including accompanying documents, to ensure applicant eligibilityProcesses requests for privileges, ensuring compliance.Prepares credential files for presentation to Clinical Executive GroupMonitors the initial, reappointment and expiration process for all employed clinical providers, ensuring compliance with regulatory bodies

Qualifications

Education & Experience:Bachelor’s degree preferred; at least 3+ years of experience, with a preference to individuals with experience directly related to a hospital, physician group, managed care or outpatient practice credentialing. Preference will be given to: National Association Medical Staff Services (NAMSS) certification as a Certified Medical Services Manager (CPMSMS) or Certified Provider Credentials Specialist (CPCS).

Special Skills:Demonstrated ability to effectively communicate both written and verbally required. Ability to think and work independently, meet deadlines and ensure that assigned projects are completed in a timely and efficient manner. Effective interpersonal skills. Working knowledge of Microsoft Office suite. Valid driver’s license required in incumbent’s name

EEO Statement

Bancroft stands strong against racism and hate of all kinds and supports actions leading to respect, equality, fairness and peace. We advocate for and embrace an inclusive and just world. One world. For everyone. We work with heart, respect and collaboration. We are communicators, listeners, problem solvers, partners and collaborators. Bring your authentic self to our team.  

Bancroft is an Equal Opportunity Employer, and supports diversity, equity and inclusion in its hiring and employment practices, so that every team member can feel a true sense of belonging, and maximize their unique potential.  To this end, all applicants will receive consideration for employment without regard to age, race, color, religion, sex, national origin, ancestry, marital status, affectional or sexual orientation, gender identity or expression, disability, veteran status or any other characteristic protected by law. 

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