MANAGER - PAYOR CONTRACTING and CREDENTIALING

MANAGER - PAYOR

CONTRACTING and

CREDENTIALING

Liberty Health - 3.2 Wilmington, NC Job Details Full-time 9 hours ago Qualifications Medicare Regulatory compliance CMS regulatory compliance Centers for Medicare and Medicaid Services (CMS) Document management Cross-functional collaboration Escalation handling Full Job Description There's no place like Liberty Health Come explore career opportunities with Liberty Health , a dynamic leader in the healthcare industry. Join us! We are currently seeking an experienced:

MANAGER OF PAYOR

CONTRACTING and

CREDENTIALING JOB SUMMARY

Oversee administrative management of payor contracts for SNF, Home Health, and Hospice services, including Medicare Advantage, Medicaid managed care, commercial insurers, and VA Community Care Network (CCN). Coordinate payor contract intake, routing, tracking, renewals, and amendments in partnership with Legal, Finance, and Operations departments. Maintain organized contract files and monitor contract status to ensure timely renewals and ongoing compliance. Assist with due diligence and contracting activities for new providers, service expansions, and acquisitions under the direction of legal leadership. Manage initial enrollment, CHOW applications, credentialing, re-credentialing, and revalidation processes for provider entities, facilities, and clinicians.

Ensure timely completion of:

CMS Medicare enrollment and revalidation (PECOS) State Medicaid enrollment and re-enrollment Medicare Advantage and commercial payor credentialing VA credentialing and CCN participation requirements Monitor enrollment expirables and revalidation cycles to avoid lapses in payor participation or interruptions in payment. Prepare and submit accurate and complete enrollment and credentialing applications to payor portals. Manage the credentialing, re-credentialing, and ongoing payor enrollment of Nurse Practitioners supporting Palliative Care services across Skilled Nursing, Home Health, and Hospice settings. Oversee credentialing and payor participation for Nurse Practitioners serving Liberty Medicare Advantage ISNP and CSNP programs , ensuring compliance with plan-specific participation, delegated credentialing requirements, and network adequacy standards. Coordinate Nurse Practitioner enrollment and credentialing with: Medicare and Medicare Advantage plans (including ISNP and CSNP products) State Medicaid, as applicable Commercial payors and delegated entities Ensure Nurse Practitioner credentialing files contain required licensure, certifications, malpractice coverage, collaborative or supervisory agreements (as applicable), and payor-specific documentation. Track Nurse Practitioner credentialing expirables, re-credentialing cycles, and payor participation status to prevent gaps in coverage or reimbursement. Serve as the main liaison between Legal, Clinical Leadership, and Medicare Advantage plan representatives for Nurse Practitioner credentialing matters related to Palliative, ISNP, and CSNP programs. Identify and escalate credentialing risks, denials, or participation issues affecting plan compliance, network participation, or payment. Ensure enrollment and credentialing activities comply with CMS Conditions of Participation, state licensure requirements, and payor standards. Identify and escalate contract, enrollment, or credentialing risks, denials, or deficiencies to Legal leadership. Support responses to payor audits, corrective action plans, and enrollment-related inquiries. Maintain documentation to support regulatory, legal, and payor reviews. Maintain tracking tools and dashboards to monitor contract status, credentialing cycles, and revalidation deadlines. Develop and adhere to standardized workflows, checklists, and controls for contracting and credentialing processes. Act as the primary point of contact for internal stakeholders regarding payor enrollment and credentialing status. Collaborate with Revenue Cycle and Billing teams to resolve enrollment-related payment or denial issues. Partner with Legal, Compliance, Finance, Revenue Cycle, and Operations teams to support organizational objectives. Communicate payor participation requirements to facility and agency leadership. Support organizational readiness for surveys, audits, and payor reviews related to enrollment and contracting.

JOB REQUIREMENTS

Bachelor's degree preferred; preferred fields include healthcare administration, business, legal studies, or a related area. 3-5 years of experience in healthcare payor contracting, provider enrollment, credentialing, or similar compliance roles. Experience in postacute care (SNF, Home Health, and/or Hospice) is strongly preferred. Working knowledge of Medicare, Medicaid, Medicare Advantage, commercial payors, and VA credentialing processes. Familiarity with CMS enrollment and revalidation requirements (PECOS). Strong organizational and document management skills. High attention to detail and ability to manage multiple deadlines simultaneously. Ability to recognize compliance and contractual risks and escalate them appropriately. Strong written and verbal communication skills. Regulatory and contractual compliance Detail-oriented execution Risk awareness and escalation Cross-functional coordination Process discipline and documentation Timely completion of all credentialing and revalidation cycles No preventable lapses in payor enrollment Accurate and complete contract documentation Effective escalation of issues to Legal Reduced delays or denials of claims due to enrollment issues Visit www.libertycareers.com for more information. Background checks/drug-free workplace. EOE.

Location:

Liberty Health •

Legal Schedule:

Full Time, Day (8), 8-5p