Credentialing & Enrollment Specialist - Provider Data

Capital Health (US); New York (NY); On-site; USD 28,000 - 36,000; Full time

Benefits offered by this job

Medical Plan

Prescription drug coverage & In-House

Dental Plan

Vision Plan

Flexible Spending Account (FSA)

Healthcare FSA

Dependent Care FSA

Retirement Savings and Investment Plan

Basic Group Term Life and AD&D

Disability Benefits – LTD

Disability Benefits – STD

Employee Assistance Program

Commuter Transit

Commuter Parking

Supplemental Life Insurance

Voluntary Life Insurance

Paid Time-Off Program

Job summary

Capital Health seeks a Credentialing Specialist to manage end-to-end credentialing and enrollment, acting as a strategic liaison between providers, insurance entities and revenue cycle. The role requires strong data integrity, analytical skills and attention to detail to safeguard timely reimbursement.

Responsibilities include audits of provider files, timely enrollment, and maintenance of data across multiple systems.

Qualifications

• Education: High school diploma or equivalency.
• Experience: One year provider credentialing and/or enrollment in a medical office.
• In lieu of experience, three years Revenue Cycle experience in contracting, billing, or administration.
• Strong communication, customer service, organization, attention to detail, and accuracy.
• Proficiency in Windows-based processing, Excel, and credentialing software.

Responsibilities

• Maintains expert understanding of accreditation and insurance regulations.
• Reviews provider credentials to ensure state, federal, and payer compliance.
• Trains across payer platforms to ensure accuracy and efficiency.
• Updates plans and systems to comply with mandates.
• Manages end-to-end enrollment to optimize reimbursement and cash flow.
• Completes reports and analyzes payer data for revenue assurance.
• Resolves credentialing and enrollment issues with payers and admins.
• Acts as liaison between providers, leadership and insurance representatives.

Skills

Communication

Customer service

Organizational skills

Attention to detail

Prioritization

Credentialing software

Excel

Windows processing

Education

High school diploma

Tools

Excel

Credentialing software

Job description

Capital Health seeks a Credentialing Specialist to manage end-to-end credentialing and enrollment, acting as a strategic liaison between providers, insurance entities and revenue cycle. The role requires strong data integrity, analytical skills and attention to detail to safeguard timely reimbursement.

Responsibilities include audits of provider files, timely enrollment, and maintenance of data across multiple systems.