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About the Role

VillageCare is seeking a Credentialing Specialist to ensure the provider network meets regulatory and internal standards by coordinating credentialing and recredentialing activities and maintaining accurate, audit-ready records. This role manages assigned cases end-to-end, partnering with the CVO and internal stakeholders to resolve discrepancies and maintain complete files.

Responsibilities

• Coordinate credentialing and recredentialing activities.
• Maintain accurate, audit-ready records.
• Manage assigned cases end-to-end.
• Partner with the Credentials Verification Organization (CVO) and internal stakeholders to resolve discrepancies.
• Ensure provider files are complete.
• Perform credentialing for organizational and institutional providers.
• Review submissions for completeness and accuracy.
• Track case status and document actions.
• Draft provider status correspondence.
• Prepare Credentialing Committee agendas and compliance reports.
• Complete sanction/exclusion and Medicare opt-out checks.
• Support primary source verification (PSV) for internal clinical staff.
• Assist with delegation oversight audits and related documentation.
• Check queues and dashboards.
• Align priorities with the Manager of Contract Execution and Provider Onboarding.
• Update records in the credentialing platform, Excel trackers, and shared folders.
• Conduct follow-ups and status updates.
• Ensure communications are clear, properly documented, and ready for review.
• Organize materials for meetings and committee deadlines.
• Confirm supporting documentation is in place.
• Respond to audit or oversight requests.

Requirements

• 1-3 years in healthcare credentialing/enrollment/provider data or managed care operations (preferred)
• Strong Excel skills (formulas, pivot tables, filtering, tracking)
• High attention to detail, organization, and follow-through

Skills

• Excel
• Credentialing
• Enrollment
• Provider data management
• Managed care operations
• Attention to detail
• Organization
• Follow-through

Location

• Hybrid
• NY/NJ/CT

Work Type

• Hybrid
• Full-time

Experience Level

• 1-3 years

Education Level

• Bachelor's degree preferred
• NAMSS or related credentialing training a plus

Salary/Compensations

• $58,039.56 - $65,294.40 Annually

About the Company

• VillageCare is a community-based, not-for-profit organization serving people with chronic care needs, as well as seniors and individuals in need of continuing care and managed care services.
• Our mission is to promote healing, better health and well-being to the fullest extent possible.
• Our care is offered through a comprehensive array of community and residential programs, as well as managed care.
• VillageCare has delivered quality health care services to individuals residing within New York City for over 45 years.