Credentialing Specialist

Center for Disability Services, Inc.; City of Albany (NY); On-site; USD 36,000 - 39,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

401(k) Retirement Savings Plan

Employee Assistance Program

Paid Time Off

Tuition Reimbursement

Early Access to Pay with RAIN

Public Service Loan Forgiveness (PSLF)

Job summary

The Center for Disability Services, Inc. is seeking a Credentialing Specialist to support our healthcare team in credentialing and re-credentialing activities, maintaining records, and coordinating with payers, licensing boards, and internal stakeholders.

Responsibilities include handling initial and renewal credentialing, fact-checking licenses and certifications, preparing submissions, and ensuring NCQA/JCO/CMS compliance.

Qualifications

• High School diploma or equivalent.
• At least 2 years of credentialing, provider enrollment, healthcare administration, or related experience.

Responsibilities

• Coordinate the initial credentialing, re-credentialing, and privileging processes for healthcare providers.
• Verify provider qualifications, including licenses, certifications, education, training, work history, malpractice coverage, and professional references.
• Prepare and submit credentialing applications to insurance payers and regulatory agencies.
• Monitor provider licenses, certifications, DEA registrations, and other required credentials for expiration and renewal.
• Maintain accurate provider records in credentialing databases and document management systems.
• Ensure compliance with NCQA, Joint Commission, CMS, state, and organizational credentialing requirements.
• Conduct primary source verification and maintain supporting documentation.
• Track application statuses and follow up with providers, payers, and credentialing entities as needed.
• Assist with audits, accreditation reviews, and regulatory reporting requirements.
• Respond to provider and stakeholder inquiries regarding credential status and requirements.
• Generate reports and analyze credentialing data to support operational and compliance objectives.
• Collaborate with provider enrollment, contracting, compliance, and operations teams.

Education

High School diploma or equivalent

Tools

CAQH

PECOS

NPPES

Job description

Where people get better at life!

Join us in our mission to make a difference and shape a more inclusive future.

The Center for Disability Services offers hope, innovation and achievement to the people we support. For 80 years, we have been one of upstate New York's largest providers of programs and services for individuals who have disabilities. Many of the innovative programs and vital services that we offer are not available elsewhere.

We are searching for a Credentialing Specialist to join our Center Health Care Team!

This role supports healthcare providers by managing credentialing and re-credentialing activities, maintaining accurate records, and coordinating with insurance payers, licensing boards, and internal stakeholders.

Responsibilities:

• Coordinate the initial credentialing, re-credentialing, and privileging processes for healthcare providers.

• Verify provider qualifications, including licenses, certifications, education, training, work history, malpractice coverage, and professional references.

• Prepare and submit credentialing applications to insurance payers and regulatory agencies.

• Monitor provider licenses, certifications, DEA registrations, and other required credentials for expiration and renewal.

• Maintain accurate provider records in credentialing databases and document management systems.

• Ensure compliance with NCQA, Joint Commission, CMS, state, and organizational credentialing requirements.

• Conduct primary source verification and maintain supporting documentation.

• Track application statuses and follow up with providers, payers, and credentialing entities as needed.

• Assist with audits, accreditation reviews, and regulatory reporting requirements.

• Respond to provider and stakeholder inquiries regarding credential status and requirements.

• Generate reports and analyze credentialing data to support operational and compliance objectives.

• Collaborate with provider enrollment, contracting, compliance, and operations teams.

Requirements:

• High School diploma or equivalent

• At least 2 years of experience in credentialing, provider enrollment, healthcare administration, or related experience

Experience Preferred:

• Certified Provider Credentialing Specialist (CPCS) certification.

• Experience with CAQH, PECOS, NPPES, and provider enrollment systems.

• Familiarity with NCQA, Joint Commission, CMS, and state licensing requirements.

• Experience in a medical group, health plan, or healthcare organization.

At The Center for Disability Services, we don't just accept difference - we celebrate it, support it, and thrive on it for the benefit of our employees and the people we support. We're proud to be an Equal Opportunity Employer and do not discriminate against any protected class of job applicant or employee in our employment practices.

Compensation Range:

$26.00 - $28.00

Benefits:

• Medical Insurance
• Dental Insurance
• Vision Insurance
• 401(k) Retirement Savings Plan
• EAP (Employee Assistance Program)
• Generous Paid Time Off (PTO)
• Tuition Reimbursement
• Early Access to Pay with RAIN
• Public Service Loan Forgiveness (PSLF)