Provider Contracting & Credentialing Coordinator

Overview

Immanuel Pathways PACE® is seeking a Provider Contracting & Credentialing Coordinator to work at Immanuel Home Office located at 1044 North 115th Street, Omaha, NE  68154.

Pay will be based upon experience, certifications, skills and education.

Best in Class Benefits can be found at Immanuel:

• HEALTH: Medical, dental, vision, Health Savings Account (HSA), and Flexible Spending Account (FSA)
• LIFE INSURANCE: Employer Paid Life Insurance
• TIME OFF: Paid Time Off - accruing from day one of employment, Floating Holidays, Paid Holidays, 8 hours of Volunteer Time Off per year
• RETIREMENT: 401K with employer match
• WELLNESS: Wellness Program and Employee Assistance Program
• GROWTH AND DEVELOPMENT: Advancement opportunities (as appropriate) – we look to grow from within our organization, Education Assistance Program – we invest up to $5,250 per year for education assistance paid up front
• Plus many more benefits!

Job Duties & Skills Required

What You Will Do

Supports the Provider Network Manager through provider network administration, contract lifecycle management, Primary Care Provider credentialing, and oversight of the PACE Out-of-Network process. Serves as the primary administrator for Out-of-Network requests and associated contracting activities while supporting provider network operations, contract administration, compliance monitoring, and scheduling initiatives. Collaborates with Compliance, Legal, Finance, Operations, Scheduling, and Center leadership to ensure efficient provider network administration, regulatory compliance, and participant access to services. Supports and lives out Immanuel’s Mission and CHRIST Promises.

Skills & Requirements

Key Areas

Key Responsibilities and Duties of the Job

Out-of-Network Program Administration

• Serves as the primary administrator and subject matter expert for the Out-of-Network (OON) process.
• Maintains and oversees the OON workflow from request initiation through contract execution, service completion, and closure.
• Maintains the OON tracking system and ensures all requests are accurately documented and monitored.
• Reviews OON requests for completeness and coordinates follow-up with requestors as needed.
• Provides onboarding, training, and ongoing support to designated employees responsible for initiating OON requests, including Primary Care Providers, Social Workers, Care Transition Nurse Case Managers, Executive Directors, and Medical Directors.
• Monitors adherence to established OON workflows and identifies opportunities for process improvement.
• Ensures temporary, single-case, and out-of-network agreements are appropriately closed once services are complete or no longer needed.
• Collaborates with providers and internal stakeholders to facilitate timely contracting and authorization of OON services.
• Provides routine updates regarding OON activity, trends, and process compliance to Sr. Provider Network Manager.
• Serves as the primary resource for operational questions related to the OON process.
• Develops and maintains OON workflows, tools, and reference materials to promote consistency and compliance across the organization.
• Identifies opportunities to transition recurring OON services to contracted providers and escalates network needs to the Sr. Provider Network Manager.

Provider Network Operations & Contract Administration

• Supports the Sr. Provider Network Manager in the administration and maintenance of the contracted provider network.
• Maintains and oversees a comprehensive contract tracking system for all in-network and out-of-network provider agreements, including contract requests, new agreements, amendments, renewals, and terminations, ensuring accurate tracking from initiation through execution, implementation, and closure.
• Coordinates contract routing, review, approval, and execution processes with internal and external stakeholders.
• Conducts follow-up with providers and internal departments to facilitate timely contract completion.
• Maintains contract records and supporting documentation in Contract Guardian and other designated systems.
• Maintains the Provider Network Listing and ensures provider information is current and consistent across designated systems, including the T: Drive and ZingTree.
• Assists with provider onboarding and implementation activities following contract execution.
• Supports network maintenance activities and special projects as assigned by the Sr. Provider Network Manager.
• Monitors upcoming contract expirations and assists with renewal preparation and coordination.
• Ensures provider demographic, participation, and contractual information remains accurate and up to date.

Scheduling Operations Support

• Assists Scheduling Leadership with operational support activities, special projects, and process improvement initiatives.
• Supports maintenance and optimization of scheduling, referral, and provider workflow processes.
• Assists with referral work queue cleanup, provider maintenance activities, and scheduling-related administrative projects, as needed.
• Provides cross-functional support between Scheduling, Provider Network, and Center Operations teams to ensure efficient coordination of services.

Compliance

• Ensures provider network, credentialing, contracting, and Out-of-Network activities comply with CMS, state, organizational, and PACE requirements.
• Completes implementation audit checklists following contract execution.
• Monitors compliance with established provider network, credentialing, and OON workflows and requirements.
• Conducts OIG exclusion screenings for prospective contracted vendors and facilities, including both In-Network and Out-of-Network entities, and reports any potential matches to the Compliance Officer for review and follow-up.
• Reviews and maintains documentation of CMS Preclusion List monitoring reports, identifies contracted vendors or facilities that may appear on the list, and escalates findings as appropriate.
• Participates in quality improvement initiatives related to provider contracting, participant access, scheduling operations, and network management.
• Maintains compliance with departmental and organizational policies, procedures, and confidentiality standards.
• Participates in required compliance education, training, and organizational initiatives.

Primary Care Provider Credentialing & Maintenance

• Responsible for the credentialing and ongoing monitoring process of PACE Primary Care Providers.
• Coordinates collection, verification, and maintenance of credentialing documentation in accordance with organizational and regulatory requirements.
• Maintains credentialing records and monitors licensure, certifications, insurance coverage, and other required credentialing elements.
• Ensures timely recredentialing and monitoring activities are completed.
• Collaborates with internal stakeholders to support Primary Care Provider credentialing compliance and documentation requirements.

5% Other

• Performs other duties as required or requested.

QUALIFICATIONS

Education-

• Post high-school education is required.
• Bachelor’s degree in business administration or related field is preferred.
• Equivalent years of experience may substitute for education requirement.

Experience-

• Two (2) years’ experience in a higher-level administrative role, preferably in the healthcare industry, is required.
• Previous business or healthcare management experience preferred.
• Previous experience with contract management and analytics is preferred.
• Equivalent years of education may substitute for experience requirement.

Other Requirements-

• Must have a valid driver’s license, proof of insurance and have reliable means of transportation.
• Agree to abide by the mission, promises, philosophy, practices, and protocols of Immanuel as well as specific community or center.

Immanuel

At Immanuel, we believe that our success is built on the collective strength of our people.  Here’s why you’ll thrive as part of our team:

• Meaningful work: You won’t just have a job; you will have a purpose.  Our Mission impacts the lives of our residents/participants and their families, one another, and our community.
• Growth Opportunities: We invest in your development.  Whether it’s mentorship, training, or advancement, we’re committed to your growth.
• Inclusive Culture: We celebrate uniqueness and foster an environment where everyone feels valued.
• Work-Life Harmony: We believe in allowing you to thrive by leveraging your passion.  Achieve your best work while maintaining a healthy work-life harmony.
• Total Rewards: A focus on feedback and recognition, competitive compensation, a robust benefits package, and perks beyond the basics.
• Intentional Experience: We are very intentional about your employee experience, from Day One Orientation to how we onboard new managers and invest in quarterly and annual leadership training.  

 Join us at Immanuel and be a part of something extraordinary.  Your journey starts here.

• Immanuel is an Equal Opportunity Employer and participates in E-Verify.
• A background check and drug screen will be required prior to hire.
• Applicants must be currently authorized to work in the United States on a full-time basis.