Healthfirst

Perform credentialing and recredentialing of non-delegated providers and vendors, facilities and groups in accordance with established credentialing policies and procedures and NYS and CMS credentialing regulations. Work collaboratively with Vendor Management Specialist and designated Credentialing Verifications Organization (CVO) and audit monthly files. Troubleshoot issues and outreach to necessary internal and external contacts as required to obtain credentialing and recredentialing documents. Prepare, review, update and/or audit committee summaries and present them to the Credentialing Committee as applicable. Participate in internal and external meetings to respond to inquiries and define credentialing requirements for stakeholders.

Duties/Responsibilities

The Senior Credentialing Specialist is responsible for the credentialing and recredentialing of Healthfirst non-delegated providers and vendors, facilities and groups and ensures credentialing and recredentialing documents and files are complete and accurate in accordance with Healthfirst Credentialing Policies and Procedures and NYS and CMS credentialing regulations.

• Perform primary source verifications and query necessary databases including but not limited to the following: CAQH, NPDB, NSCH, ABMS, AOA, AMA, etc.

• Troubleshoot issues and outreach to necessary internal and external contacts as required to obtain credentialing and recredentialing documents.

• Actively participate with and support the development of internal provider systems used to intake, track and monitor provider credentialing.

• Prepare, review and/or audit flagged/unclean files for presentation to the Credentialing Committee as applicable.

• Develop job aids, workflows, and policies as procedures and systems evolve 

• Participate in internal and external meetings to respond to inquiries and define credentialing requirements for stakeholders.

• Prepare bi-weekly clean file approval lists for medical directors

• Additional duties/tasks as assigned

Minimum Qualifications

• 8+ years of credentialing experience

• Bachelor’s degree or equivalent combination of education and experience

• Proficiency in MS Word, Excel, Outlook

• Superior organizational and follow up skills

• Strong attention to detail

Preferred Qualifications

• Excellent verbal and written communication skills.

• Troubleshooting and conflict resolution skills; ability to escalate to leadership when necessary

• Ability to train others on credentialing/recredentialing requirements.

• File auditing experience

• Proficiency in PowerPoint and OneNote

Compliance & Regulatory Responsibilities

The Senior Credentialing Specialist is responsible for the Credentialing and Recredentialing of Healthfirst  providers and ensures that the credentialing documents and files are complete and accurate in accordance with Healthfirst Credentialing Policies and Procedures, and Federal and State Credentialing Regulations.

Hiring Range*:

• Greater New York City Area (NY, NJ, CT residents): $67,205 - $95,680

• All Other Locations (within approved locations): $59,800 - $87,360

As a candidate for this position, your salary and related elements of compensation will be contingent upon your work experience, education, licenses and certifications, and any other factors Healthfirst deems pertinent to the hiring decision.

In addition to your salary, Healthfirst offers employees a full range of benefits such as, medical, dental and vision coverage, incentive and recognition programs, life insurance, and 401k contributions (all benefits are subject to eligibility requirements). Healthfirst believes in providing a competitive compensation and benefits package wherever its employees work and live.

*The hiring range is defined as the lowest and highest salaries that Healthfirst in “good faith” would pay to a new hire, or for a job promotion, or transfer into this role.

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.