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 issues appropriately
Demonstrated success in building and maintaining high-performing teams
PHYSICAL DEMANDS (The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.) While performing the duties of this job, the employee is frequently required to talk or hear, walk, sit; use hands to finger, handle, or feel. The employee is occasionally required to stand. The employee must occasionally lift and/or move up to 10 lbs.
WORK ENVIRONMENT (The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. ) While performing the duties of this position, the employee performs tasks in a temperature-controlled office envir