Healthcare Credentialing & Enrollment Specialist

Rumcsi; New York (NY); On-site; USD 60,000 - 65,000; Full time

Job summary

Richmond University Medical Center is seeking a Day Shift Credentialing Specialist to join our healthcare credentialing team in New York. You will review practitioner applications, verify documentation, and ensure eligibility and compliance for payer enrollment.

The role requires proven experience in healthcare credentialing, excellent communication, strong organizational skills, and strict confidentiality to protect provider files.

Qualifications

• High school diploma or GED required.
• Proven experience in healthcare provider credentialing and payer enrollment.
• Minimum of 1 year of experience working within a physician billing or third-party payer environment.
• Strong, practitioner-focused communication skills with the ability to explain complex credentialing and enrollment processes clearly.
• Excellent organization, time management, and customer service skills.
• Absolute commitment to maintaining strict confidentiality regarding proprietary information and provider files.
• Proficient with data entry, MS Office Suite (Word, Excel, Outlook, PowerPoint), and Symplr credentialing software.
• Ability to thrive under tight deadlines and manage a high-volume workload efficiently.

Responsibilities

• Coordinate and monitor the review and analysis of practitioner applications and supporting documentation to ensure eligibility and compliance.
• Conduct thorough background investigation, research and primary source verification of all components within credentialing/payer enrollment files.
• Identify credentialing and enrollment discrepancies that require additional investigation; facilitate appropriate follow-ups to resolve issues effectively.
• Prepare, track, and secure required practitioner signatures for enrollment files in a timely manner to avoid onboarding delays.
• Utilizes Symplr credentialing database to retrieve credentialing documents in accordance with the Health Care Quality Improvement Act.
• Collaborate with Richmond Health Network's administration to ensure seamless information exchange during the practitioner on-boarding and off-boarding processes.
• Perform miscellaneous job-related duties and special projects as assigned.

Skills

Credentialing experience

Payer enrollment experience

Communication skills

Organization skills

Confidentiality

MS Office

Symplr credentialing software

Education

High school diploma or GED

Tools

MS Office Suite

Symplr credentialing software

Job description

Richmond University Medical Center is seeking a Day Shift Credentialing Specialist to join our healthcare credentialing team in New York. You will review practitioner applications, verify documentation, and ensure eligibility and compliance for payer enrollment.

The role requires proven experience in healthcare credentialing, excellent communication, strong organizational skills, and strict confidentiality to protect provider files.