Credentialing Specialist

Position: CREDENTIALING SPECIALIST
OUR VISION

To continue as an eminent healthcare provider on Long Island, dedicating ourselves to providing exceptional health care for all our patients and to transform both the lives of the individual, and the community, for the better, one person at a time.

OUR MISSION

To provide access to equitable, optimal healthcare by improving the overall wellness of all individuals in our communities and delivering high quality comprehensive patient centered care.

OUR VALUE PROPOSITION

To provide whole person care that will ensure that all patients have access to primary, specialty and social health care to achieve and maintain optimal wellness at a transparent and affordable cost. The Harmony Healthcare Long Island is a non-profit healthcare organization with 7 health centers, providing primary care and preventative medicine in the following locations in Nassau County:
Roosevelt, Elmont, Hempstead, Freeport, Oceanside, and New Cassel/Westbury. In addition, the Harmony Healthcare Long Island has 4 school-based health centers, WIC offices (Special Supplemental Nutrition Program for Women, Infants, and Children) in 3 locations, and a Health Home Care Coordination program. As federally qualified health centers, we serve the individuals in our communities, providing enhanced services, expanded hours and reduced prescription pricing, while raising the level of care.

We treat patients regardless of income, residency or immigration status.

The Harmony Healthcare Long Island offers a stable employment opportunity with a growing company, and competitive base compensation along with health and dental insurance, paid time off, 401-K with company match, paid holidays, employee discounts and much more.

JOB TITLE:

Credentialing Specialist

REPORTS TO:

Chief Financial Officer

We are seeking a detail-oriented and experienced Credentialing Specialist to credential, recredential and enroll our healthcare providers into managed care plans. This role ensures that all providers meet the necessary licensing, certification, and regulatory requirements in compliance with internal policies and external standards (e.g., NCQA).

The ideal candidate is a team player with a strong background in healthcare credentialing and managed care enrollment, and a passion for ensuring operational excellence and regulatory compliance.

RESPONSIBILITIES:

* Oversee the end-to-end credentialing, recredentialing and managed care enrollment process for all providers.

* Verify provider credentials through primary source verification (PSV) methods.

* Maintain and update provider information in credentialing databases (e.g., CAQH, Cred Stream).

* Monitor license, DEA, board certification, and insurance expiration dates.

* Ensure compliance with applicable regulatory standards (NCQA).

* Develop, update, and enforce credentialing policies and procedures.

* Respond to internal and external credentialing/enrollment inquiries in a timely and professional manner.

* Prepare credentialing/enrollment reports for leadership and assist with audits and surveys.

* Collaborate with internal departments such as HR, Compliance, Finance and Medical Staff.

QUALIFICATIONS:

* Associate or bachelor's degree in healthcare administration or related field preferred.

* 5+ years of experience in healthcare credentialing required.

* In-depth knowledge of credentialing standards and regulatory requirements.

* Proficiency with credentialing software (e.g., CAQH, Cred Stream).

* Strong attention to detail, time management, and organizational skills.

* Excellent verbal and written communication skills.

* CPCS or CPMSM certification (through NAMSS) preferred or willing to obtain within 18 months.

Benefits:

* 401(k)

* Dental insurance

* Employee assistance program

* Flexible spending account

* Health insurance

* Health savings account

* Life insurance

* Paid time off

* Retirement plan

* Vision insurance

EXPERIENCE:

* Credentialing: 2 years (Required)

LICENSE/CERTIFICATION:

* Certified Provider Credentialing Specialist (Preferred)

Work Location:

In person, potential for hybrid