• Responsible for managed care contract administration,provider services, and managed care organizationsupport.• Manage the strategic, tactical, and negotiating phases ofcontracting with managed care payers for fee for servicearrangements.• Negotiate and implement single case agreements.• Provide oversight for payor credentialing.• Fee schedule management.• Responsible for enrolling facilities with payors.• Oversee physician contracting functions.• Provide contract implementation of managed careagreements within the department, as well as withinternal and external customers.• Develops and maintains relationships with payers andwith customers to effectively manage contracts andresolve issues.• Compiles and analyzes internal and external informationas it relates to managed care contracts.• Provides support for physician organizations (i.e., behavioral health, weight loss, cardiac, general surgery and trauma, urgent care centers, and medical imaging facilities). • Maintain contract pipeline management process.• Develop and maintain the standard conditions and termsfor contracts with managed care payers.• Draft, review and negotiate professional managed carepayer contracts for assigned payers.• Work closely with revenue cycle function to monitormanaged care payer payment and procedural compliance• Keep abreast of payer updates and CMS updates.• Leads joint operating committee (JOC) meetings withassigned managed care payers. • Prepare agendas and data for presentations at the meetings.• Meet with MWHC leadership monthly to provide payerupdates and payer contract updates.• Attends events to keep abreast of current methodologiesand approaches.

• Responsible for all functions related to healthcare worker andother contractor staff credentialing re-credentialing andprivileging in accordance with regulatory/compliance guidelinesand requirements.• Responsible for obtaining and verifying credentials, certification, state licensures, and other professional credentials as well as maintaining on-going checks to ensure that all credentials remain current.• Responsible for enrolling practitioners and group practices with Medicaid and Medicare.• Initiated and followed through all aspects of the credentialingprocess, including initial and recredentialing, for all healthcareand other staff as needed.• Maintained the currency of all assigned credentialing files.• Conduct various background checks from a wide variety ofsources as needed to verify the credentials and suitability ofcandidates, including but not limited to: NPDB, OIG/SAM,ABMS Board Certification and the National StudentClearinghouse.• Document all work performed to ensure that all information isproperly recorded and tracked.• Maintained patient confidentiality, and confidentiality of allrecords, in compliance with the Privacy Act and HIPAAregulations in all work activities.• Attends and participated in all general staff meetings.• Conduct peer interviews.• Responsible for timely and accurately re-submitting claims dueto credentialing error in EPIC database.• Processed claims to all payers.• Maintain and updated provider rosters.• Partnered with the Managed Care contracting team, PatientFinancial Services and Revenue Cycle as it relates to claimpayment and processing.• Completed all EPIC billing/claim edits due to credentialing.• Identified opportunities for revenue cycle performance improvements.