Contract & Credentialing Manager

Full–time

Posted on: 8 days ago

Role Overview:
You will be joining Forta, a company dedicated to revolutionizing healthcare by utilizing AI and machine learning to improve patient care. Specifically, you will be part of the team focused on enhancing access to autism ABA therapy, a crucial service that currently faces limitations and fragmentation. Your role will involve providing administrative and operational support to the payor relations and contracting team, ensuring smooth operations and high-quality service delivery.

Key Responsibilities:
- **Problem Solving:**
- Be the primary point of contact for resolving complex contracting, credentialing, and licensing issues.
- Proactively identify and address bottlenecks in provider contracting processes.
- Foster strong relationships with payors and internal teams to expedite issue resolution.

- **Operations:**
- Oversee end-to-end provider contracting procedures, including submissions, amendments, and renewals.
- Guarantee compliance with payer and state regulations.
- Maintain accurate records of contracts, credentialing documents, and provider interactions.

- **Data Management and Reporting:**
- Utilize expertise to ensure high-quality provider data integrity in internal systems.
- Regularly audit and validate data for accuracy and cleanliness.
- Develop and maintain dashboards, reports, and KPIs to monitor team performance and operational metrics.
- Provide insights and identify trends for process enhancement and strategic planning.

- **Team Leadership and Process Improvement:**
- Lead, coach, and support team members, ensuring high performance and accountability.
- Establish and enforce standard operating procedures (SOPs) for consistent and efficient workflows.
- Continuously seek opportunities to streamline processes and enhance operational efficiency.
- Contribute to cross-functional initiatives such as new market launches and expansion endeavors.

Qualifications:
- Bachelors degree in Healthcare Administration, Business, or related field preferred (or equivalent experience).
- 35 years of managerial experience in healthcare administration, contracting support, credentialing, or payor relations.
- Strong organizational and scheduling skills with the ability to manage multiple deadlines accurately.
- Excellent written and verbal communication skills.
- Proficiency in Microsoft Office Suite (Excel, Word, Outlook, PowerPoint); experience with CRM, Smartsheet, or contract management software is advantageous.
- Comfortable working autonomously in a structured, process-oriented remote environment.
- Detail-oriented, reliable, and dedicated to maintaining accuracy.

Additional Company Details:
Forta is at the forefront of transforming healthcare by leveraging AI and machine learning to enhance patient care. The company's primary focus is on improving access to autism ABA therapy, a critical service that is currently facing challenges due to limited availability and fragmented delivery. By joining Forta, you will be part of a mission-driven team dedicated to providing early and high-quality access to care for individuals with autism. Role Overview:
You will be joining Forta, a company dedicated to revolutionizing healthcare by utilizing AI and machine learning to improve patient care. Specifically, you will be part of the team focused on enhancing access to autism ABA therapy, a crucial service that currently faces limitations and fragmentation. Your role will involve providing administrative and operational support to the payor relations and contracting team, ensuring smooth operations and high-quality service delivery.

Key Responsibilities:
- **Problem Solving:**
- Be the primary point of contact for resolving complex contracting, credentialing, and licensing issues.
- Proactively identify and address bottlenecks in provider contracting processes.
- Foster strong relationships with payors and internal teams to expedite issue resolution.

- **Operations:**
- Oversee end-to-end provider contracting procedures, including submissions, amendments, and renewals.
- Guarantee compliance with payer and state regulations.
- Maintain accurate records of contracts, credentialing documents, and provider interactions.

- **Data Management and Reporting:**
- Utilize expertise to ensure high-quality provider data integrity in internal systems.
- Regularly audit and validate data for accuracy and cleanliness.
- Develop and maintain dashboards, reports, and KPIs to monitor team performance and operational metrics.
- Provide insights and identify trends for process enhancement and strategic planning.

- **Team Leadership and Process Improvement:**
- Lead, coach, and support team members, ensuring high performance and accountability.
- Establish and enforce standard operating procedures (SOPs) for consistent and efficient workflows.
- Continuously seek opportunities to streamline processes and enhance operational efficiency.
- Contribute to cross-