Credentialing Coordinator
4 days ago
The Bronx
Credentialing Coordinator Essen Health Care is the place where care comes together! We are looking for the most talented and effective individuals to join our rapidly growing company. With over 1,100 employees and 400+ practitioners, we care for over 250,000 patients annually in New York City and beyond. From medical providers to administration & operational staff, there is a career here for you. Join our team today! Job Summary Credentialing Coordinator's primary objective is to coordinate and support the day-to-day credentialing activities for clinical providers, including Primary Care Providers, Specialists, and Ancillary Providers. The role requires an assertive, proactive individual who takes initiative, learns quickly, and follows instructions accurately to ensure timely and compliant credentialing outcomes. Responsibilities • Comply with Credentialing Policy and Procedures, Departmental Guidelines and Company Policy, • Follow established timelines for processing and completion of applications, • Process and submit Medicaid initial enrollment, revalidation, and re-credentialing applications across multiple states, including NY, TX, OH, PA, MA, NE, and NJ, in compliance with state-specific requirements., • Navigate and maintain enrollments within state Medicaid portals and systems (e.g., NYS Medicaid, TMHP, MITS, PROMISe™, MA MMIS, NJ MMIS), ensuring accuracy and completeness of provider records., • Monitor application statuses, follow up on outstanding actions, and respond promptly to requests for additional information or corrections., • Track state-specific revalidation cycles and deadlines to prevent lapses, denials, or terminations in Medicaid participation., • Coordinate with internal teams such as Office Administrators and Revenue Cycle Management (RCM) to resolve Medicaid enrollment issues impacting claims and reimbursement., • Work directly with providers and practice staff to obtain, verify, and maintain required documentation, including licenses, DEA, board certifications, practice locations, and ownership disclosures., • Identify, troubleshoot, and escalate complex or delayed Medicaid enrollment issues, including system errors, site visits, or compliance flags., • Maintain accurate credentialing logs, trackers, and documentation to support audits and reporting requirements., • Ensure all Medicaid credentialing activities adhere to federal, state, and organizational compliance standards., • Complete other tasks or projects assigned Qualifications Education Experience: • Bachelor's Degree in a Health-Related Discipline: Public Health, Healthcare Administrative, Health Service, Psychology or Sociology Highly Preferred, • Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) a plus, • Experience in a multi-specialty medical group or large healthcare organization, • Strong interpersonal and communication skills with an ability to work effectively with a wide range of people, teams, managers, supervisors, and vendors., • Proficient with MS Office (outlook, word, excel, power point, access), • Excellent organizational and time-management skills., • Excellent verbal and written communication skills., • Ability to analyze, interprets and draws inferences from research findings, and prepares reports., • Working knowledge of clinical operations and procedures., • Informational research skills., • Ability to use independent judgment to manage and impart confidential information., • Database management skills including querying, reporting, and document generation. Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Position Type and Expected Hours to Work: Full-Time Position Monday through Friday from 9:00 a.m. to 5:30 p.m. – 40 hours work week Travel: No travel is expected or required for this position. Supervisor Responsibility: As described above. Equal Opportunity Employer Essen Health care is proud to be an equal opportunity employer, and we seek candidates who desire to work in and serve an ethnically diverse population.