Credentialing Specialist, Bureau of Revenue

City of New York; New York (NY); On-site; USD 70,000 - 100,000; Full time

Benefits offered by this job

Loan Forgiveness

Health insurance

Work From Home Policy

Public sector pension

Job summary

The New York City Department of Health and Mental Hygiene is seeking a Credentialing Specialist to verify qualifications of clinical providers and ensure compliance with regulatory standards. The role supports the financial health of the revenue stream by maintaining accurate provider data and timely enrollment with payers.

Responsibilities include reviewing credentials, coordinating enrollments with Medicare/Medicaid, and updating CAQH Proview/NPPES profiles while ensuring HIPAA compliance and

Qualifications

• Bachelor’s degree or higher from an accredited college or university.
• 2–3 years’ experience as a credentialing specialist in a healthcare organization.
• Experience with NY State and Federal Credentialing systems (NPPES, PECOS).
• Familiarity with Managed Care contracting and enrollment process.
• Knowledge of third-party reimbursements and adjudication process.

Responsibilities

• Verify credentials - review licenses, medical education, training and certifications.
• Coordinate provider enrollment with Medicare, Medicaid, and commercial plans.
• Maintain provider profiles in CAQH Proview, PECOS, NPPES.
• Monitor license expirations and revalidations; initiate ETIN renewals.
• Meet with clinical team for annual ETIN and onboarding applications.
• Update billing data bases to support billing for providers.

Skills

Detail-oriented

Communication

HIPAA compliance

Multitasking

Team collaboration

Problem solving

Education

Bachelor’s degree or higher

Tools

CAQH Proview

PECOS

NPPES

Job description

The Bureau of Revenue is responsible for collecting $1.3 billion of revenue generated around the city of New York. The patient billing unit with a target goal of $4k, is responsible for fulfilling New York State Article 6 requirements to do due diligence by collecting insurance information from patients who are insured to bill third party payers for reimbursements to offset cost of providing care to the uninsured or under insured. The Patient billing unit continuously manages, develops and implements policies that support the values, vision and mission of the agency.

Position Summary: Reporting to the Director of Patient Billing , the Credentialing Specialist will be responsible for the verification of all new and existing clinical provider’s qualifications to ensure that they meet legal regulatory standards for patient care, and organizational tasks to promote the financial health of the revenue stream. Applicants must be detailed oriented and must have a working knowledge of credentialing in the healthcare industry.

Job Duties and Responsibilities

• Verification of Credentials - Reviews professional licenses, medical education, training, and certification (e.g. board certification, DEA registration).
• Provider Enrollment - Coordinates enrollment with insurance networks (e.g., Medicare, Medicaid, and commercial plans) to ensure providers are in network to be eligible for reimbursement.
• Database Management - Maintain up-to-date provider profile in databases like CAQH Proview, PECOS, and NPPES.
• Compliance Monitoring - Tracks expiration dates for licenses, health plan revalidations, and proactively initiating ETIN renewals to prevent revenue disruptions.
• Meet with clinical team - on or offsite clinic visits with providers to complete annual ETIN and onboarding applications.
• Update Billing Data Bases - Update billing system with provider billing credentials to facilitate billing.
• Assist Billing Team - perform third-party billing and collection activities within the billing system(s) when assigned.

Preferred Skills

• Bachelor’s degree or higher from an accredited college or university.
• Minimum of 2-3 years’ experience as a credentialing specialist in a healthcare organization.
• Experience with Article 28, 31, and 36 clinic billing Preferred.
• Experience in the various NY State and Federal Credentialing systems, e.g. NPPES and PECOS
• Familiar with Managed Care (MCO) contracting and enrollment process.
• Knowledge of third-party reimbursements and adjudication process.
• Experience with Article 28, 31, and 36 clinic billing Preferred.
• Ability to multi-task and perform accounting computations is required.
• Knowledge of Medical billing and coding +plus
• Ability to communicate effectively with staff and other stakeholders across the agency.
• Extreme attention to detail, strong communication for interacting with providers and health payers and the ability to handle confidential HIPAA-protected data. Proficiency in Microsoft office (Excel/Word).
• Excellent customer service and interpersonal skills. Excellent problem solving and critical thinking skills. In-depth knowledge of industry best practices. Ability to work independently, collaborate with others, multitask, and a team player.

Why you should work for us

• Loan Forgiveness: As a prospective employee of the City of New York, you may be eligible for federal/state loan forgiveness and repayment assistance programs that lessen your payments or even fully forgive your full balance. For more information, please visit the U.S. Department of Education’s website (https://studentaid.gov/pslf/)
• Benefits city employees are entitled to unmatched benefits such as:
• o a premium-free health insurance plan that saves employees over $10K annually, per a 2024 assessment.
• o additional health, fitness, and financial benefits may be available based on the position’s associated union/benefit fund.
• o a public sector defined benefit pension plan with steady monthly payments in retirement.
• o a tax-deferred savings program and
• o a robust Worksite Wellness Program that offers resources and opportunities to keep you healthy while serving New Yorkers.
• Work From Home Policy: Depending on your position, you may be able to work for up to two days during the week from home.
• Job Security - you could enjoy more job security compared to private sector employment and be able to contribute to making NYC a healthy place to live and work.

Established in 1805, the New York City Department of Health and Mental Hygiene (NYC Health Department) is the oldest and largest health department in the U.S., dedicated to protecting and improving the health of NYC. Our mission is to safeguard the health of every resident and cultivate a city where everyone, regardless of age, background, or location, can achieve their optimal health. We provide a wide array of programs and services focused on food and nutrition, anti-tobacco support, chronic disease prevention, HIV/AIDS treatment, family and child health, environmental health, mental health, and social justice initiatives. As the primary population health strategist and policy authority for NYC, with a rich history of public health initiatives and scientific advancements, from addressing the 1822 yellow fever outbreak to the COVID-19 pandemic, we serve as a global leader in public health innovation and expertise.

Come join us and help to continue our efforts in making a difference in the lives of all New Yorkers!

Commitment to Equity

The City of New York is an inclusive equal opportunity employer committed to recruiting and retaining a diverse workforce and providing a work environment that is free from discrimination and harassment based upon any legally protected status or protected characteristic, including but not limited to an individual's sex, race, color, ethnicity, national origin, age, religion, disability, sexual orientation, veteran status, gender identity, or pregnancy.

The NYC Health Department is an inclusive equal opportunity employer committed to providing access and reasonable accommodation to all individuals. To request reasonable accommodation to participate in the job application or interview process, contact Sye-Eun Ahn, Director of the Office of Equal Employment Opportunity, at [e-mail] or 347-396-6549.

Minimum Qualifications

1. A master's degree from an accredited college with a specialization in business or public administration, financial management, or public health, and two years of full-time satisfactory experience in employee benefits or health insurance as a manager, research analyst, or underwriter, or in public health education. One year of such experience must have been in group benefits or group health insurance; or
2. A baccalaureate degree from an accredited college and three years of full-time satisfactory experience as described above; or
3. Education and/or experience equivalent to "1" or "2" above. Certification as a Certified Employee Benefits Specialist from the International Foundation of Employee Benefit Programs can be substituted for one year of experience. However, all candidates must have at least a baccalaureate degree and one year of experience in group benefits or group health insurance as described in "1" above.

55a Program

This position is also open to qualified persons with a disability who are eligible for the 55-a Program. Please indicate at the top of your resume and cover letter that you would like to be considered for the position through the 55-a Program.

Public Service Loan Forgiveness

As a prospective employee of the City of New York, you may be eligible for federal loan forgiveness programs and state repayment assistance programs. For more information, please visit the U.S. Department of Education’s website at https://studentaid.gov/pslf/.

Residency Requirement

New York City residency is generally required within 90 days of appointment. However, City Employees in certain titles who have worked for the City for 2 continuous years may also be eligible to reside in Nassau, Suffolk, Putnam, Westchester, Rockland, or Orange County. To determine if the residency requirement applies to you, please discuss with the agency representative at the time of interview.

Additional Information

The City of New York is an inclusive equal opportunity employer committed to recruiting and retaining a diverse workforce and providing a work environment that is free from discrimination and harassment based upon any legally protected status or protected characteristic, including but not limited to an individual's sex, race, color, ethnicity, national origin, age, religion, disability, sexual orientation, veteran status, gender identity, or pregnancy.

INSURANCE ADVISOR (HEALTH) - 40236