Medical Insurance Contracting Specialist

The leading cardiology group in the West Valley is expanding and looking to add valuable and skilled team members to our comprehensive and long-standing Practice.

Cardiac Solutions provides a personalized, team-oriented approach to patient care by promoting wellness through education, innovation, and technology. We offer intensive educational opportunities for patients through our disease management clinics and employ a multidisciplinary approach. All team members play a vital role in providing our patients with tailored care and support services. Our focus helps to prevent the progression of heart disease and minimize hospital admissions for our patients.

• Competitive wages
  
• Uniform/Scrub Allowance
  
• Monday ? Friday for most positions
  

• 401(k) retirement plan
  

• Paid Sick Time
  
• Employee Assistance & Discount Programs
  

The Medical Insurance Contracting Specialist is responsible for managing all aspects of insurance contracting for providers and the organization. This includes the development, negotiation, and maintenance of healthcare contracts in compliance with federal, state, and local regulations, as well as internal standards. The specialist works closely with the Director of Revenue Cycle Management (RCM) to ensure timely communication of new contracts, updates to existing agreements, and changes to billing policies.

• Prepare, submit, and maintain insurance contracts, provider directories, rosters, and credentialing/recredentialing documentation.
  
• Support the Director of RCM in negotiating contracted rates with payers across multiple states.
  
• Maintain and update the database of credentialed providers and organizational records.
  
• Investigate and resolve issues related to the contracting process.
  
• Communicate contractual terms and updates to the billing department; ensure policies are revised accordingly.
  
• Maintain accurate online directories for contracted insurance carriers, including provider demographics and practice locations.
  
• Ensure compliance with all applicable laws, regulations, and internal policies, including the Standards of Conduct and Code of Ethics.
  
• Manage malpractice coverage documentation for all providers and the organization.
  
• Develop knowledge of standardized credentialing, licensing, and privileging processes.
  
• Maintain strict confidentiality in all aspects of the role.
  
• Perform other duties as assigned.