Credentialing Lead -Healthcare (In Person)
$66,300–$76,000 year
On-siteThe Bronx, New York, United States
Job Summary
Oversee the complete lifecycle of provider credentialing, including file review, verification, committee preparation, and ongoing monitoring. Present credentialing packets to the Credentialing Committee, manage meeting agendas and minutes, and coordinate annual audits and delegation reports. Perform primary source verification for licensure, board certification, and malpractice history, while tracking expirables and adverse actions across regulatory databases. Supervise staff, conduct file audits, and collaborate with Medical Directors and internal departments to ensure compliance with NCQA, TJC, CMS, and state regulations. Prepare verification payment requests and generate reports for leadership.
Required Qualifications
- 3–5 years of healthcare credentialing or medical staff services experience
- Bachelors or 7 years of relevant working experience
- 1–2 years of supervisory or team lead experience
- Strong knowledge of NCQA, TJC, CMS, and State regulatory standards
- Excellent attention to detail, organization, and ability to manage multiple priorities
- Strong communication skills and ability to work with executive and clinical leadership
- Monday through Friday from 9:00 a.m. to 5:00 p.m. – 40 hours work week
- No travel is expected or required
Desired Qualifications
- Certified Notary - New York State
- CPCS or CPMSM certification (or willingness to obtain)
- Experience with credentialing systems (MD Staff, Medallion, Passport, MD Staff, Modio, etc.)
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