Credentialing and Contracting Specialist

Job Title
Credentialing and Contracting Specialist
Job ID
27757877
Location
St.Paul, MN, 55114 
Other Location
Description

Position Summary:

The Credentialing and Contracting Specialist is responsible for managing payer credentialing, contract maintenance, and regulatory compliance for ActivStyle, a DME/HME organization. This role ensures the company meets all requirements to participate in Medicare, Medicaid, and commercial insurance programs while maintaining proper licensing and accreditation for all operations. 

ActivStyle specializes in incontinence, urology, ostomy, enteral nutrition, and wound care products. This position is essential in ensuring accurate provider enrollment, timely access to reimbursement, and alignment with federal and state laws and payer requirements.

Essential Functions and Job Responsibilities: 

  • Manage payer credentialing, re-credentialing, and enrollment for Medicare, Medicaid, managed care organizations (MCOs), and commercial insurance networks across multiple states. 
  • Maintain and track all state licenses (e.g., HME/DME licenses through Boards of Pharmacy), city licenses, and applicable DBAs.
  • Submit and maintain filings, including W-9s, bonds, NPI registrations, and insurance coverage documents; ensure they remain current and compliant.
  • Maintain and update records in credentialing systems (e.g., CAQH, PECOS, NPPES, Availity) and internal tracking tools.
  • Oversee contract documentation, including payer agreements, fee schedules, and amendments; manage renewal timelines and contract lifecycle.
  • Provide compliance and contracting support across departments, acting as a subject matter expert in payer policy requirements and enrollment standards.
  • Collaborate closely with the Compliance Officer to support the preparation and submission of documentation for external audits and regulatory reviews.
  • Monitor changes in federal and state regulations (e.g., Medicare/Medicaid rules, HIPAA) to support organizational compliance initiatives.
  • Maintain organized files of all provider and business credentials, insurance documents, and state-level filings.
  • Identify, report, and escalate potential fraud, waste, or abuse (FWA) and security risks related to protected health information (PHI) promptly and accurately.
  • Uphold and promote the organization’s core values and maintain positive relationships with government agencies, insurance plans, and accrediting bodies.
  • Ensure that safety standards are upheld in the workplace and report any concerns or incidents promptly.
  • Perform other duties as assigned. 

 Competency, Skills and Abilities: 

  • Strong written and verbal communication skills.
  • High degree of accuracy and attention to detail.
  • Strong organizational and time-management skills; able to prioritize multiple tasks in a fast-paced environment.
  • Ability to meet deadlines
  • Ability to maintain confidentiality and exercise discretion when handling sensitive information.
  • Critical thinker with a proactive, collaborative approach to problem-solving.
  • Proficient computer skills and knowledge of Microsoft Office
  • Ability to prioritize and manage multiple tasks
  • Solid ability to learn new technologies and possess the technical aptitude required to understand flow of data through systems as well as system interaction

Education and Experience Requirements: 

  • Bachelor’s degree or equivalent combination of education and experience.
  • Prefer 3–5 years of experience in payer enrollment, credentialing, contracting, or compliance within the healthcare industry—preferably in DME/HME.
  • Familiarity with state and federal healthcare regulations, including HIPAA, Medicare, Medicaid, and state licensing requirements.
  • Working knowledge of credentialing platforms such as CAQH, PECOS, and NPPES. 

Physical Demands and Work Environment: 

  • Work environment may be stressful at times, as overall office activities and work levels fluctuate
  • Must be able to bend, stoop, stretch, stand, and sit for extended periods of time
  • Subject to long periods of sitting and exposure to computer screen
  • Ability to perform repetitive motions of wrists, hands, and/or fingers due to extensive computer use
  • Must be able to lift 30 pounds as needed 

This position is eligible for Medical, Dental, Vison, 401k, PTO, Sick & Safe time for applicable states, Holiday pay. The compensation range for this role is $45,000-$65,000. 

Pay Range
$45,000.00   Annually to $65,000.00   Annually

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