Logo for Healthfirst

Credentialing Specialist

Role overview

Qualifications

  • HS diploma/GED
  • Bachelor’s degree
  • Prior relevant experience
  • Time and project management, critical/creative thinking, communication, and problem-solving skills

Responsibilities

  • Credentials providers, facilities, and vendors in accordance to regulations and Healthfirst policy
  • Prepares presentations for the quarterly credentialing and delegate vendor oversight committee meetings
  • Facilitates pre-delegation and delegation vendor audits to ensure adherence to contractual arrangements
  • Reviews relevant data to ensure accuracy

Key facts

Other skills

  • Microsoft Office
  • Time Management
  • Critical Thinking
  • Creative Thinking
  • Communication
  • Problem Solving
  • Microsoft Excel
  • Microsoft PowerPoint

About the company

Healthfirst logo

Healthfirst

Health Insurance (Payers)

Healthfirst is a provider-sponsored health insurance company that serves more than 1.8 million members in downstate New York. Healthfirst offers top-quality Medicaid, Medicare Advantage, Child Health Plus, and Managed Long Term Care plans. Healthfirst Leaf Qualified Health Plans and the Healthfirst Essential Plan are offered on NY State of Health, The Official Health Plan Marketplace. Healthfirst offers Healthfirst Pro and Pro Plus, Exclusive Provider Organization (EPO) plans for small-business owners and their employees, and Healthfirst Total, an EPO for individuals. For more information on Healthfirst, visit www.healthfirst.org

Company details

Company typeLarge
IndustryHealth Insurance (Payers)
Company size1001 - 5000

Your match analysis

See how your profile stacks up against this role.

We compared the job requirements to your profile to show where you're strong and where you fall short.

Job description

The Healthfirst Credentialing department credentials and re-credentials providers, facilities and vendors; prepares hard-copy directories and reviews network provider data for accuracy and ensures compliance with regulatory requirements and federal and state regulations.

Duties/Responsibilities:

  • Credentials providers, facilities, and vendors in accordance to regulations and Healtfirst policy.
  • Prepares presentations for the quarterly credentialing and delegate vendor oversight committee meetings.
  • Facilitates pre-delegation and delegation vendor audits to ensure adherence to contractual arrangements.
  • Prepares hard-copy directories and works with third party vendors for posting online directories.  Reviews relevant data to ensure accuracy.
  • Effectively communicates to internal departments and external partners.     
  • Identifies and assesses opportunities to improve processes to better ensure regulatory compliance and adherence to state and federal regulations.
  • Raises issues to management and assists in resolution.
  • Additional duties as assigned.

Minimum Qualifications:

  • HS diploma/GED

Preferred Qualifications:

  • Bachelor’s degree
  • Prior relevant experience
  • Time and project management, critical/creative thinking, communication, and problem-solving skills.
  • Intermediate Microsoft software skills include Adobe, Access, Excel, Word, PowerPoint, and Office

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to race, color, religion, gender, gender identity, sexual orientation, national origin, age, genetic information, military or veteran status, marital status, mental or physical disability or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

If you have a disability under the Americans with Disability Act or a similar law and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to careers@Healthfirst.org or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.

EEO Law Poster and Supplement

All hiring and recruitment at Healthfirst is transacted with a valid “@healthfirst.org” email address only or from a recruitment firm representing our Company. Any recruitment firm representing Healthfirst will readily provide you with the name and contact information of the recruiting professional representing the opportunity you are inquiring about. If you receive a communication from a sender whose domain is not @healthfirst.org, or not one of our recruitment partners, please be aware that those communications are not coming from or authorized by Healthfirst.  Healthfirst will never ask you for money during the recruitment or onboarding process.

Apply once. Then go straight to the hiring manager.

After you apply, unlock the direct contact details of the people who actually make the call. A quick follow-up makes you 5x more likely to land an interview.

MR

Marcus Rivera

Chief Revenue Officer

m.rivera@company.com
linkedin.com/in/marcusrivera
Unlocked after you apply
·

Related jobs

Other jobs at Healthfirst

Premium

Reach out to the hiring manager directly.

Gain access to the contact details of the hiring managers who actually decide, and reach out to network with them directly. That, plus more when you upgrade:

  • Full match report with fit score and gaps
  • Career diagnostics on how recruiters read you
  • Curated company matches and warm intros
  • 48h early access to new roles

Cancel anytime.