Contract Administration Supervisor



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Job Description

The primary focus of the Contract Administration Supervisor is to manage the application, credentialing and health plan filing processes, while providing guidance, support and information for payor escalations, interaction with payors and questions related to contractual terms and conditions. The Contract Administration Supervisor is responsible for ensuring that team and individual goals are reached, as well as, ensure timely responses, quality assurance, and adherence to departmental and company policies and procedures, as well as federal and state guidelines including Medicare and Non-Medicare payor requirements.

PRIMARY DUTIES AND RESPONSIBILITIES

Manage the application, credentialing and health plan filing processes, ensuring that all information is submitted timely and accurately.

Provide guidance, support and information for payor escalations, interaction with payors and questions related to contractual terms and conditions.

Maintain current records of applicable company and employee information for disclosure, taking all necessary measures to appropriately safeguard confidential and sensitive information.

Review payer contracts and prepare contract worksheets and reimbursement analysis documents for legal and executive review.

Support in the creation and ongoing maintenance of a database of contractual requirements relative to provider obligations and requirements

Maintain internal reference guides, directories and databases of payer participation, billing and compliance requirements and fee schedules.

Review and distribute payer manuals, newsletters, bulletins and memos to applicable departments, communicating pertinent requirements and/or updates.

Provide direct oversight of vendor relationships supporting credentialing and licensure to ensure accurate information, as well as no lapse in coverage

Maintain website access for users company-wide.

Manage deadlines and priorities effectively with scheduled and ad hoc goals and assignments.

Manage professional meetings and communications.

Maintain all soft and hard copy contract and filing records.

Responsible for tracking daily productivity.

ANCILLARY DUTIES AND RESPONSIBLITIES

Provide daily/weekly updates on application, credentialing, licensure, and contract status to RCM Leadership, as well as applicable stakeholders

Complete work assignment of Payor Relations/Contract Management to designated team members

Monitor Contract Management processes to ensure adherence to departmental and company policies and procedures, as well as federal and state guidelines including Medicare and Non-Medicare payor requirements

Work collaboratively with the Finance and Legal/Compliance to ensure timely review of contracts and fees schedules

Support the Contract Management team as subject matter expert, providing guidance where applicable; Researching and resolving issues identified in relation to health plan participation as well as, communicating and/or escalating issues and areas of opportunity to leaders in other departments to ensure resolution.

Assist and support RCM Leadership in the development, documentation, implementation, and management of policy/procedures and revisions that are responsive to changes in internal protocol.

All other projects and tasks as assigned

REPORTING RELATIONSHIP RESPONSIBILITIES

Provides work direction plus has responsibility for hiring, promotions, transfers, performance management, discipline, and discharge.

MINIMUM REQUIREMENTS

Education:

High School Diploma or GED required

Experience:

• •Minimum 2 years of experience in healthcare credentialing, provider enrollment, payer contracting, or revenue cycle management
• •Minimum 1 year of supervisory or team lead experience, including responsibility for work direction, performance management, and employee development
• •Demonstrated experience managing credentialing and provider enrollment processes
• •Experience with health plan filing and state licensing requirements

Technical Knowledge:

• •Working knowledge of CAQH and PECOS enrollment systems
• •Basic understanding of Medicare and commercial payer participation requirements
• •Intermediate proficiency with Microsoft Office Suite (Word, Excel, PowerPoint)
• •Experience with database software (Access or similar)
• •Ability to navigate payer portals and online credentialing systems

Core Skills:

• •Ability to read, analyze, and interpret contract language and technical procedures
• •Strong mathematical skills including ability to calculate contract rates, fee schedules, discounts, and percentages
• •Analytical reasoning and problem-solving abilities
• •Clear oral and written communication skills
• •Ability to manage multiple deadlines and priorities effectively
• •Demonstrated organizational skills and attention to detail

PREFERRED QUALIFICATIONS

Education:

• •Associate's degree or Higher in Business Administration, Healthcare Administration, or related field
• •Professional certification such as CPCS (Certified Provider Credentialing Specialist), CPMSM (Certified Professional in Medical Services Management), or similar credentialing certification

Experience:

• •3+ years of progressive experience in healthcare credentialing, provider enrollment, or payer contracting
• •2+ years of supervisory experience with direct responsibility for hiring, promotions, performance management, and disciplinary actions
• •Experience working with multiple payer types including Medicare, Medicaid, Commercial Insurance, and Managed Care Organizations
• •Previous experience reviewing payer contracts and conducting reimbursement analysis
• •Experience managing vendor relationships for credentialing and licensure services
• •Background working in a multi-state healthcare organization or with multi-state provider credentialing

Technical Knowledge:

• •Advanced knowledge of Medicare and Non-Medicare payor requirements and compliance guidelines
• •Expertise in contract language review and reimbursement methodologies (fee-for-service, capitation, value-based arrangements)
• •Experience with call center telecommunications software (Softphones or similar)
• •Familiarity with revenue cycle management systems and credentialing software platforms
• •Knowledge of state-specific licensing requirements across multiple jurisdictions
• •Understanding of federal and state healthcare compliance regulations (HIPAA, Stark Law, Anti-Kickback Statute)

Advanced Skills:

• •Proven ability to conduct payer escalations and resolve complex contractual issues
• •Experience developing and implementing departmental policies and procedures
• •Strong stakeholder management skills with demonstrated ability to collaborate across Legal, Compliance, Finance, and Operations departments
• •Advanced analytical skills including ability to forecast workflow processes and identify process improvement opportunities
• •Experience with employee coaching, productivity tracking, and team development
• •Demonstrated group presentation skills and ability to conduct effective meetings
• •Track record of maintaining quality assurance standards while meeting productivity goals
• •Experience creating and maintaining contract databases and internal reference materials

Leadership Competencies:

• •Proven ability to serve as a subject matter expert and provide guidance to team members
• •Experience managing team performance metrics and daily productivity tracking
• •Strong decision-making skills with ability to escalate