Credentialing Specialist
hace 6 días
Glendale
Job DescriptionAbout the Role We’re looking for a Credentialing Specialist to join our team and support the full lifecycle of provider credentialing and contract management. This role is essential to ensuring compliance, timely enrollment, and operational readiness across our healthcare programs. Location: Brooklyn NY (hybrid schedule) Pay rate: $30+ depending on education and experience Key Duties • Audit and maintain facility credentials and staff listings., • Secure contracts with key Managed Care Organizations (MCOs), prioritizing those with active patient engagement., • Coordinate delegation agreements when applicable to hiring processes., • Confirm all clinical staff are properly enrolled in Medicaid and Medicare., • Maintain current and accurate CAQH profiles for all providers., • Validate NPPES taxonomy codes for all staff accounts., • Facilitate cross-training and shadowing opportunities to support team collaboration., • Develop and manage a tracking system for contract statuses and timelines., • Collaborate with Revenue, HR, and Program Directors to meet payer enrollment deadlines., • Lead provider enrollment efforts for MDs, NPs, PAs, LCSWs, and LMHCs in accordance with the 21st Century Cures Act., • Review and reconcile Tax IDs, billing NPIs, and contract documentation., • Analyze claim denials and pursue single case agreements for out-of-network services., • Identify and prioritize contracts that require negotiation or renewal., • Ensure all Article 31 and 32 programs are properly enrolled with both existing and new contracts.What You Bring, • Bachelor degree in Health Administration or related (preferred), Associate degree (required), • Proven experience in healthcare credentialing and payer contracting., • Familiarity with Medicaid, Medicare, CAQH, NPPES, and MCO processes., • Strong attention to detail and organizational skills., • Analytical mindset with the ability to interpret claim trends and enrollment data., • Experience mentoring or training team members is a plus. Pay Details: $30.00 to $35.00 per hour Search managed by: Marissa Osorio Benefit offerings available for our associates include medical, dental, vision, life insurance, short-term disability, additional voluntary benefits, EAP program, commuter benefits and a 401K plan. Our benefit offerings provide employees the flexibility to choose the type of coverage that meets their individual needs. In addition, our associates may be eligible for paid leave including Paid Sick Leave or any other paid leave required by Federal, State, or local law, as well as Holiday pay where applicable. Equal Opportunity Employer/Veterans/Disabled To read our Candidate Privacy Information Statement, which explains how we will use your information, please navigate to The Company will consider qualified applicants with arrest and conviction records in accordance with federal, state, and local laws and/or security clearance requirements, including, as applicable: • The California Fair Chance Act, • Los Angeles City Fair Chance Ordinance, • Los Angeles County Fair Chance Ordinance for Employers, • San Francisco Fair Chance Ordinance Massachusetts Candidates Only: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability. ]]>