Credentialing Specialist, Bureau of Revenue

City of New York • Long Island City, NY

4d • Hybrid

About The Position

The Bureau of Revenue's patient billing unit is responsible for collecting revenue and fulfilling New York State Article 6 requirements by collecting insurance information from patients to bill third-party payers for reimbursements. This unit manages and implements policies that support the agency's values, vision, and mission. The Credentialing Specialist will verify the qualifications of new and existing clinical providers to ensure they meet legal regulatory standards for patient care and contribute to the financial health of the revenue stream. This role requires attention to detail and knowledge of healthcare credentialing.

Requirements

• Detailed oriented
• Working knowledge of credentialing in the healthcare industry
• Ability to multi-task and perform accounting computations
• Knowledge of Medical billing and coding
• Ability to communicate effectively with staff and other stakeholders across the agency.
• Extreme attention to detail
• Strong communication for interacting with providers and health payers
• Ability to handle confidential HIPAA-protected data.
• Proficiency in Microsoft office (Excel/Word).
• Excellent customer service and interpersonal skills.
• Excellent problem solving and critical thinking skills.
• In-depth knowledge of industry best practices.
• Ability to work independently, collaborate with others, multitask, and a team player.

Nice To Haves

• Bachelor’s degree or higher from an accredited college or university.
• Minimum of 2-3 years’ experience as a credentialing specialist in a healthcare organization.
• Experience with Article 28, 31, and 36 clinic billing Preferred.
• Experience in the various NY State and Federal Credentialing systems, e.g. NPPES and PECOS
• Familiar with Managed Care (MCO) contracting and enrollment process.
• Knowledge of third-party reimbursements and adjudication process.

Responsibilities

• Verification of Credentials: Reviews professional licenses, medical education, training, and certification (e.g. board certification, DEA registration).
• Provider Enrollment: Coordinates enrollment with insurance networks (e.g., Medicare, Medicaid, and commercial plans) to ensure providers are in network to be eligible for reimbursement.
• Database Management: Maintain up-to-date provider profile in databases like CAQH Proview, PECOS, and NPPES.
• Compliance Monitoring: Tracks expiration dates for licenses, health plan revalidations, and proactively initiating ETIN renewals to prevent revenue disruptions.
• Meet with clinical team: on or offsite clinic visits with providers to complete annual ETIN and onboarding applications.
• Update Billing Data Bases: Update billing system with provider billing credentials to facilitate billing.
• Assist Billing Team: perform third-party billing and collection activities within the billing system(s) when assigned.

Benefits

• Loan Forgiveness
• Premium-free health insurance plan
• Additional health, fitness, and financial benefits may be available based on the position’s associated union/benefit fund.
• Public sector defined benefit pension plan
• Tax-deferred savings program
• Robust Worksite Wellness Program

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level