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Credentialing Specialist

Department: Finance - Billing
Location: Peekskill, NY

Job Description 

POSITION: Credentialing Specialist

LOCATION: Peekskill, NY


REPORTS TO: Supervisor of Credentialing 


POSITION STATUS: Temporary - Full-Time


Hudson River HealthCare provides the highest quality comprehensive primary, preventive, and behavioral health services to all who seek it, regardless of insurance status and ability to pay, especially for the underserved and vulnerable. Hudson River Health Center (“HRHCare”) a Federally Qualified, Non-For-Profit Health Center serving communities in Suffolk County. HRHCare is currently seeking the following healthcare professional to join our team at our main office in Peekskill. We currently have the need for a full-time, temporary Credentialing Specialist.

A Credentialing Specialist is responsible for the credentialing, tracking panel participation and re-credentialing of all Hudson River HealthCare providers into all managed care organizations and insurance plans, (including Medicaid and Medicare). S/he will perform other duties as assigned or requested. In addition, perform job duties in compliance with systems and job specific standards.

Essential Job Duties and Responsibilities:


  •  Establishes and maintains Provider Relations contact for each MCO.
  •  Identifies with Provider Relations Rep what providers can be credentialed in each organization (i.e., MDs, NPs, DPMs, ODs, CNMs, PAs, DDS, CSW) - including all sites.
  •  Identifies third party administrator organization that various MCOs contract with to credential their specialty providers who they might not credential (such as mental health, pods, opt, CNMs, NPs, PAs, etc.).
  •  Submits copy of Provider Agreements, Contracts and Fee Schedules to Vice President of Information, PM and Billing Manager for review before submitting any applications.
  •  Following review by Vice President of Information, PM and Billing, makes follow-up calls to MCO Rep. to clarify any questions that may arise.
  •  Completes application forms and agreements, gets provider signatures, provides all additional information (licenses, deas, cvs, malpractice insurance, board certs, cme, etc).Maintains copies of all in MCO binders, by provider, for future reference/faxing when MCOs inquire, prior to provider employment.
  •  Follow-up with organizations regarding completion of credentialing.
  •  Notifies Pt. Benefit Coordinators., Pt. Reps, and Data Processing Manager when providers receive verification of credentialing.
  •  Maintains MCO log, complete with Organizations, Providers Credentialed, Provider #s and distribute updates to all necessary personnel (Pt. Benefit Coords., Billing, etc.)
  •  Sees that Data Processing and Business Manager receives a copy of fee schedules for all MCOs.
  •  Performs all clerical duties related to the Operations Team, including scheduling meetings, typing minutes.
  •  Coordinates and attends meeting w/MCO and Patient Reps, Billing, etc. for orientation.
  •  Continual contact with Provider Relations Reps with yearly Recredentialing/site visits.
  •  Credentials any new incoming providers into all appropriate MCOs.
  •  Communicates to all MCOs in writing if provider leaves Health Center, with last date of employment.
  •  Make sure that if providers see patients at other sites, that provider has Provider # for each site, if necessary.
  •  Maintains and distributes any updated policies, fee schedules, etc. received from various MCOs to all applicable depts. /sites.


Minimum Education Requirement: 

Associate’s Degree

Preferred Education Requirement 

Bachelor’s Degree

Minimum Related Work Experience: 

2-4 years

Minimum Specialized Skills & Knowledge Requirement: 

Ability to communicate in English (oral and written)

We are a network of 40 community and migrant health centers located in Peekskill, Beacon, Poughkeepsie, Amenia, Dover Plains, Pine Plains, New Paltz, Goshen, Greenport, Haverstraw, Monticello, Middletown, Nyack, Suffolk County, Walden, Yonkers and the five boroughs. Annually, we serve over 185,000 patients through well over 500,000 visits throughout a nine-county region in New York State.

Interested candidates please submit your resume.

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