CREDENTIALING SPECIALIST

Harmony Health Care Long Island•Garden City, NY

13h•Hybrid

About The Position

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.

Requirements

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.

Nice To Haves

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

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.