Credentialing Specialist
$65,000–$65,000 year
Hybrid · Great Neck, New York, United States
Job Summary
Credentialing Specialist responsible for managing credentialing and re-credentialing processes for healthcare providers to ensure compliance with regulatory and organizational standards. Duties include verification of credentials, licenses, education, and work history; maintaining provider files; primary source verification; ensuring adherence to accrediting bodies (NCQA, URAC, Joint Commission) and state/federal regulations; managing credential expirations and renewals; collaborating with internal teams and external organizations; preparing credentialing reports; updating policies and procedures to improve processes. The role requires detail orientation, strong organizational skills, and effective communication with providers and cross-functional teams. Salary is $65,000 with a hybrid arrangement in Great Neck, NY.
Required Qualifications
- Associate’s or Bachelor’s degree in Healthcare Administration, Business Administration, or related field (or equivalent experience)
- 2+ years of experience in credentialing, medical staff services, or a related role in a healthcare setting
- Knowledge of credentialing standards (NCQA, URAC, Joint Commission) and federal and state regulations
- Excellent attention to detail, organizational, and time-management skills
- Strong communication and interpersonal skills, with the ability to work effectively with internal teams and external contacts
- Preferred: Certification as CPCS or CPMSM; experience in Dental Industry; familiarity with credentialing software (CAQH, Echo, Healthstream, or symplr)
- Background in healthcare administration or medical office experience
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