Healthcare Credentialing & Provider Enrollment Specialist

NYC Department of Health and Mental Hygiene; New York (NY); On-site; USD 70,000 - 100,000; Full time

Benefits offered by this job

Loan forgiveness

Health insurance

Work from home

Pension plan

Wellness program

Job summary

NYC Department of Health and Mental Hygiene seeks a Credentialing Specialist to verify qualifications of clinical providers to meet regulatory standards and support financial health of the revenue stream. You will review licenses, education, and certifications, and coordinate enrollment with insurance networks.

Ideal candidates have a bachelor’s degree or higher and 2–3 years of credentialing experience in healthcare, with familiarity of NY/state systems like NPPES and PECOS, HIPAA privacy, and

Qualifications

• Master’s degree in business, public administration, financial management, or public health with two years of related experience.
• Bachelor’s degree with three years of related experience.
• Experience with group health insurance/benefits; NY residency may apply per policy.

Responsibilities

• Verify credentials including licenses, education, training, and certification (e.g. board certification, DEA registration).
• Coordinate provider enrollment with Medicare, Medicaid, and commercial plans to ensure network eligibility for reimbursement.
• Maintain provider profiles in CAQH ProView, PECOS, and NPPES.
• Monitor license expirations and revalidations; initiate ETIN renewals to prevent revenue disruptions.
• Meet with clinical team for annual ETIN and onboarding applications, on-site or off-site.
• Update billing data bases with provider billing credentials to facilitate billing.
• Assist Billing Team with third-party billing and collection activities when assigned.

Skills

Credentialing

Provider enrollment

HIPAA compliance

Communication skills

Microsoft Office

Education

Bachelor’s degree or higher

Tools

CAQH ProView

PECOS

NPPES

Microsoft Office

Job description

NYC Department of Health and Mental Hygiene seeks a Credentialing Specialist to verify qualifications of clinical providers to meet regulatory standards and support financial health of the revenue stream. You will review licenses, education, and certifications, and coordinate enrollment with insurance networks.

Ideal candidates have a bachelor’s degree or higher and 2–3 years of credentialing experience in healthcare, with familiarity of NY/state systems like NPPES and PECOS, HIPAA privacy, and