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About the Role

The Credentialing Specialist will be responsible for verifying the qualifications of new and existing clinical providers to ensure they meet legal regulatory standards for patient care and to support the financial health of the revenue stream. This role requires attention to detail and knowledge of healthcare credentialing.

Responsibilities

Reviews professional licenses, medical education, training, and certification.
Coordinates enrollment with insurance networks for provider reimbursement eligibility.
Maintains up-to-date provider profiles in databases like CAQH Proview, PECOS, and NPPES.
Tracks expiration dates for licenses and revalidations, and initiates ETIN renewals.
Conducts onsite or offsite clinic visits with providers for ETIN and onboarding applications.
Updates billing systems with provider credentials to facilitate billing.
Assists the billing team with third-party billing and collection activities.

Requirements

Applicants must be detailed oriented.
Must have a working knowledge of credentialing in the healthcare industry.
Experience with Article 28, 31, and 36 clinic billing is preferred.
Experience in various NY State and Federal Credentialing systems, e.g. NPPES and PECOS.
Familiarity with Managed Care (MCO) contracting and enrollment process.
Knowledge of third-party reimbursements and adjudication process.
Ability to multi-task and perform accounting computations is required.
Knowledge of Medical billing and coding is a plus.
Ability to communicate effectively with staff and other stakeholders across the agency.
Extreme attention to detail.
Strong communication skills for interacting with providers and health payers.
Ability to handle confidential HIPAA-protected data.
Proficiency in Microsoft office (Excel/Word).
Excellent customer service and interpersonal skills.
Excellent problem solving and critical thinking skills.
In-depth knowledge of industry best practices.
Ability to work independently, collaborate with others, multitask, and be a team player.
A master’s degree from an accredited college with a specialization in business or public administration, financial management, or public health, and two years of full-time satisfactory experience in employee benefits or health insurance as a manager, research analyst, or underwriter, or in public health education. One year of such experience must have been in group benefits or group health insurance.
A baccalaureate degree from an accredited college and three years of full-time satisfactory experience as described above.
Education and/or experience equivalent to the above.
Certification as a Certified Employee Benefits Specialist from the International Foundation of Employee Benefit Programs can be substituted for one year of experience.
All candidates must have at least a baccalaureate degree and one year of experience in group benefits or group health insurance.

Skills

Credentialing
Provider Enrollment
Database Management
Compliance Monitoring
Billing Systems
Third-party billing
Microsoft Office (Excel/Word)
Customer Service
Interpersonal Skills
Problem Solving
Critical Thinking
Teamwork
Communication

Location

New York City

Work Type

Hybrid
Full-time

Experience Level

2-3 years experience as a credentialing specialist in a healthcare organization
2 years of full-time satisfactory experience in employee benefits or health insurance
3 years of full-time satisfactory experience
1 year of experience in group benefits or group health insurance

Education Level

Bachelor's degree or higher
Master's degree

Salary/Compensations

$70,000 to $80,000
USD 74079 - USD 78470

Benefits

Loan Forgiveness
Premium-free health insurance plan
Additional health, fitness, and financial benefits may be available
Public sector defined benefit pension plan
Tax-deferred savings program
Robust Worksite Wellness Program

About the Company

The Bureau of Revenue is responsible for collecting $1.3 billion of revenue generated around the city of New York.
The patient billing unit continuously manages, develops and implements policies that support the values, vision and mission of the agency.
Established in 1805, the New York City Department of Health and Mental Hygiene (NYC Health Department) is the oldest and largest health department in the U.S., dedicated to protecting and improving the health of NYC.
Our mission is to safeguard the health of every resident and cultivate a city where everyone, regardless of age, background, or location, can achieve their optimal health.
We provide a wide array of programs and services focused on food and nutrition, anti-tobacco support, chronic disease prevention, HIV/AIDS treatment, family and child health, environmental health, mental health, and social justice initiatives.
As the primary population health strategist and policy authority for NYC, with a rich history of public health initiatives and scientific advancements, from addressing the 1822 yellow fever outbreak to the COVID-19 pandemic, we serve as a global leader in public health innovation and expertise.
Come join us and help to continue our efforts in making a difference in the lives of all New Yorkers!

Equal Opportunity

The City of New York is an inclusive equal opportunity employer committed to recruiting and retaining a diverse workforce and providing a work environment that is free from discrimination and harassment based upon any legally protected status or protected characteristic, including but not limited to an individual's sex, race, color, ethnicity, national origin, age, religion, disability, sexual orientation, veteran status, gender identity, or pregnancy.
The NYC Health Department is an inclusive equal opportunity employer committed to providing access and reasonable accommodation to all individuals.
To request reasonable accommodation to participate in the job application or interview process, contact Sye-Eun Ahn, Director of the Office of Equal Employment Opportunity, at [email protected] or 347-396-6549.