Credentialing Specialist

Richmond University Medical Center • New York, NY

21d

About The Position

The Credentialing Specialist coordinates and monitors practitioner application reviews and supporting documentation to ensure eligibility and compliance. The role conducts background investigations, research, and primary source verification for credentialing and payer enrollment files; investigates discrepancies and follows up to resolve them; and prepares, tracks, and secures practitioner signatures to prevent onboarding delays. The specialist uses the Symplr credentialing database to retrieve credentialing documents in accordance with the Health Care Quality Improvement Act and collaborates with Richmond Health Network administration on information exchange during practitioner onboarding and offboarding. Miscellaneous job-related duties and special projects may also be assigned.

Requirements

• High school diploma or GED.
• Proven experience in healthcare provider credentialing and payer enrollment.
• At least 1 year of experience in a physician billing or third-party payer environment.
• Strong practitioner-focused communication skills and the ability to explain complex credentialing and enrollment processes clearly.
• Excellent organization, time management, and customer service skills.
• Commitment to maintaining strict confidentiality regarding proprietary information and provider files.
• Proficiency in data entry, Microsoft Office Suite (Word, Excel, Outlook, PowerPoint), and Symplr credentialing software.
• Ability to work under tight deadlines and manage a high-volume workload efficiently.

Responsibilities

• Coordinate and monitor the review and analysis of practitioner applications and supporting documentation to ensure eligibility and compliance.
• Conduct background investigations, research, and primary source verification of components in credentialing and payer enrollment files.
• Identify credentialing and enrollment discrepancies requiring investigation and facilitate follow-ups to resolve them.
• Prepare, track, and secure required practitioner signatures for enrollment files in a timely manner.
• Use the Symplr credentialing database to retrieve credentialing documents in accordance with the Health Care Quality Improvement Act.
• Collaborate with Richmond Health Network administration to support information exchange during practitioner onboarding and offboarding.
• Perform miscellaneous job-related duties and special projects as assigned.

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED