Provider Credentialing Specialist

MetroPlusHealth; New York (NY); On-site; USD 52,000 - 68,000; Full time

Job summary

MetroPlusHealth is seeking a Credentialing Coordinator to join the Credentialing Department in New York, overseeing credentialing of new providers (including Behavioral Health) and facilities, re-credentialing, and updates to provider demographics. The role emphasizes confidentiality and secure handling of credentialing documentation.

The incumbent will verify information, perform primary source verifications, and maintain provider credentialing files while supporting internal departments with

Qualifications

• Highschool Degree required; Bachelor's Degree preferred.
• 3 years of previous experience with provider credentialing processes and procedures.
• Knowledge of CACTUS preferred.
• Ability to meet time-sensitive deadlines and multi-task in a changing healthcare environment.
• Understanding of credentialing activities as they relate to initial credentialing, re-credentialing, and credentials modification(s).

Responsibilities

• Maintain communication with credentialing contacts to coordinate information for credentialing, re-credentialing, and updates.
• Review credentialing files for completion and present to Credentialing Committee.
• Perform primary source verification per regulatory guidelines and policies.
• Data entry and upkeep of provider information in credentialing databases.
• Verify license and DEA status for credentialed providers during interim periods.
• Generate and disseminate monthly credentialing updates to departments and provider groups.
• Respond to credentialing information requests and provide provider rosters as needed.
• Maintain confidentiality of credentialing documentation and files.
• Participate in audits and site reviews; support delegated file processes.

Skills

Integrity

Customer focus

Communication

Organizational skills

Multitasking

Education

High school diploma

Bachelor's degree preferred

Tools

Microsoft Word

Microsoft Excel

Microsoft Access

Job description

MetroPlusHealth is seeking a Credentialing Coordinator to join the Credentialing Department in New York, overseeing credentialing of new providers (including Behavioral Health) and facilities, re-credentialing, and updates to provider demographics. The role emphasizes confidentiality and secure handling of credentialing documentation.

The incumbent will verify information, perform primary source verifications, and maintain provider credentialing files while supporting internal departments with