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Senior Credentialing Specialist

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Healthfirst

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Location:
United States

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Category:
Health and Beauty

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Contract Type:
Not provided

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Salary:

61300.00 - 99620.00 USD / Year
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Job Description:

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.

Job Responsibility:

  • Perform primary source verifications and query necessary databases including but not limited to the following: CAQH, NPDB, NSCH, ABMS, AOA, AMA, etc
  • 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
  • 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
  • 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
  • Develop job aids, workflows, and policies as procedures and systems evolve
  • Prepare bi-weekly clean file approval lists for medical directors
  • Additional duties/tasks as assigned

Requirements:

  • 5+ years of proven credentialing experience
  • Facilities 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

Nice to have:

  • 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
What we offer:
  • Medical, dental and vision coverage
  • Incentive and recognition programs
  • Life insurance
  • 401k contributions

Additional Information:

Job Posted:
February 10, 2026

Employment Type:
Fulltime
Work Type:
Remote work
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