Job Description

Credentialing Specialist – Administration

Location:

620 Foster Avenue, Brooklyn, NY 11230

Hours:

Full Time

Monday–Thursday: 9:00 AM – 5:00 PM

Friday: 9:00 AM – 2:00 PM

The Credentialing Specialist plays a critical role in the organization by ensuring that our healthcare facilities and physicians are following federal and state guidelines and that medical providers have the necessary licenses they require. The Credentialing Specialist also maintains records of training and certifications for medical staff. Credentialing Specialists utilize their acute knowledge of medical terminology, solid research skills, and exceptional organizational skills to verify provider credentials and ensure they are able to practice responsibly while upholding Premium Health’s utmost standard of CARE: Compassion, Agility, Respect, and Excellence.

Time Commitment:

Monday–Thursday: 9:00 AM – 5:00 PM

Friday: 9:00 AM – 2:00 PM

Responsibilities:

• Credential Verification
• Review and authenticate credentials, qualifications, licenses, certifications, and other relevant documents to ensure accuracy and compliance with standards.
• Conduct credentialing and contracting with Health Insurance payors, maintain provider credentialing files and CAQH profiles, submit applications, and follow through until approval.
• Compliance Assessment
• Ensure compliance with all legal and regulatory requirements.
• Verify valid licenses, up-to-date certifications, and required educational/training standards.
• Database Management
• Help develop internal credentialing processes.
• Maintain comprehensive credentialing databases, track expiration dates, update records, and ensure accuracy and confidentiality.
• Communication and Collaboration
• Advise staff members of upcoming renewal dates.
• Work closely with providers to provide compliance guidance.
• Respond to inquiries, stay updated on credentialing requirements, and facilitate communication to resolve compliance issues.

Requirements:

• High School diploma or equivalent preferred
• Associate degree in healthcare or business administration preferred
• Ability to meet strict deadlines
• Attention to detail
• Good communication skills
• Knowledge of policies, laws, and procedures
• Strong computer skills
• Proficiency in database management
• Team-oriented with excellent multitasking, telephone, and organizational skills

Preferred:

• Prolonged periods of sitting at a desk and working on a computer
• Prolonged periods of phone communication
• May require standing, bending, or reaching

Compensation:

$23–$28 per hour, commensurate with experience

Benefits:

• Public Service Loan Forgiveness (PSLF), NHSC Loan Repayment Program
• Paid Time Off
• Medical, Dental, Vision, and Life coverage
• Employee Assistance Program
• Flexible Spending Account
• 403(b) Retirement Plans with employer matching

Skills Required