Credentialing Specialist

Credentialing Specialist Req #343 SCOTCHTOWN, 15 FORTUNE RD W, Middletown, New York, United States of America Apply Share Job Description Posted Monday, February 16, 2026 at 12:00

AM At Access:

Supports for Living and our

Access:

Network partners, we help people live the healthiest and fullest lives possible - and we support our staff in doing the same. Across our family of organizations, team members work in mental health, substance use, disability, employment, housing, and family services, doing meaningful work in a collaborative and respectful environment. We offer supportive leadership, opportunities to learn and grow, competitive benefits, and the chance to build a career with purpose. If you're looking for work that matters and a team that values what you bring, the Access Network is a great place to be.

Location:

Middletown, NY (hybrid- few days on site required)

Hours:

M-F 830 am to 5 pm Rate of pay: $28 to $30 This position is hybrid and requires on site responsibilities

OVERVIEW OF PRIMARY RESPONSIBILITES

: The Credentialing Specialist is responsible for the coordination, facilitation, and maintenance of provider credentialing, enrollment, and re-enrollment with Medicaid, Medicare, and commercial payors across medical, behavioral health, and other services. This role ensures providers are accurately enrolled, maintained in CAQH, and fully credentialed to support timely billing and compliance. Working in close collaboration with the Revenue Cycle, Payor Contracting, and Patient Accounts teams, this position helps develop strategic approaches to enrollment and reimbursement optimization. The Associate also liaises with Legal and Compliance to ensure contract accuracy and alignment with regulatory requirements.

PRIMARY FUNCTIONS

:

Provider Enrollment & Credentialing Responsibilities :

Manage timely and accurate provider enrollment with Medicaid, Medicare, and commercial payors. Initiate credentialing and enrollment protocol with new hires and internal staff Perform thorough checks of healthcare excluded provider sanction lists, including the OIG, OMIG, SAMS.gov, etc., to verify the eligibility of providers for employment and participation in government healthcare programs Ensure compliance with CAQH profile creation, attestation, and ongoing maintenance for all credentialed providers. Perform provider and location setup and ongoing maintenance in internal and external systems. Facilitate re-credentialing and Medicare/Medicaid revalidations, ensuring continuity of billing and compliance. Maintain and update critical enrollment documentation: NPI creation and maintenance CAQH creation and enrollment Provider professional licensure and COI (Certificate of Insurance) updates Roster management for delegated contracts (e.g., CBHS) Demographic updates and practice location changes Data validation responses from payors/internal departments Conduct monthly provider roster updates and license verifications. Maintain updated spreadsheets, databases, and trackers to support IPA affiliations, state requirements, and internal reporting. Participate in ongoing education and updates (e.g., CMS, PECOS, Medicaid) and provide summaries and process improvement recommendations. Support Billing, QA, HR, and other departments on credentialing/enrollment matters. Ensure timely submission and tracking of all credentialing documentation for audits or regulatory reviews (e.g., NPDB, malpractice checks).

Payor Contracting Responsibilities:

Coordinate and support contract management with all commercial payors across medical and behavioral health services. Assist in the negotiation, analysis, and execution of contracts, ensuring favorable terms and alignment with internal revenue strategies. Track contract performance and recommend improvements to optimize revenue and reduce denials. Ensure accurate documentation and dissemination of contract information to internal stakeholders. Collaborate with Revenue Cycle to streamline contract-to-payment workflows.

Staff Engagement Responsibilities:

Lead efforts to manage and support specialized programs that improve retention, such as HRSA enrollment and maintenance, NPPES, and student loan forgiveness. Complete documentation timely and accurately to ensure program compliance

ADDITIONAL FUNCTIONAL / ORGANIZATIONAL SUPPORT

Participate in cross-functional meetings to align credentialing and contracting with broader operational goals. Assist with regulatory, accreditation, and managed care audits involving credentialed providers. Work with Legal, Compliance, and leadership to implement new or updated contract strategies. Provide support for internal audits, payer inquiries , and special projects as assigned.

QUALIFICATIONS AND ATTRIBUTES

: Experience with major health plans and Independent Practice Associations ( IPA's) (e.g., Cigna, UHC, Anthem, CBHS, Carelon). Proficiency in interpreting and managing healthcare contract terms. Detail-oriented with excellent time management and organizational skills. High level of accuracy and compliance awareness . Strong interpersonal, written, and verbal communication skills. Proactive problem-solving ability with strong judgment and discretion.

Preferred:

Knowledge of behavioral health payor requirements and credentialing.

EDUCATION AND EXPERIENCE

: Bachelor's Degree in Healthcare Administration or other relevant field preferred Credentialing experience required Minimum 3 years of relevant experience in healthcare, focusing on provider enrollment , credentialing , and payor contracting in a fast-paced environment.

PHYSICAL CHARACTERISTICS

These physical demands are representative of the physical requirements necessary for an employee to perform the job's essential functions successfully. Reasonable accommodation can be made to enable people with disabilities to perform the described essential functions of the position, which are reviewed in each case. Must be capable to sit or stand in front of a computer for long-periods of time Able to work in open space floor plan Must be capable to move throughout work day Work alongside co-workers within 3 feet Must be able to move in tight spaces Occasional lifting of > _ 25+ pounds # Credentialing An Equal Opportunity Employer, including disability and Veterans Job Details Pay Type Hourly Scan this QR code and apply! Download

SCOTCHTOWN, 15 FORTUNE RD

W, Middletown, New York, United States of America