Credentialing Specialist

Credentialing Specialist

Location: Melville, NY
Type: Full-Time, On-Site
Compensation: $60,000 – $65,000/year (based on experience)

Job Summary

A healthcare organization in Melville, NY is seeking a detail-oriented and proactive Credentialing Specialist to manage physician and provider credentials. This role ensures all applications, enrollments, and credentialing processes are accurate, up-to-date, and compliant with regulatory standards. The ideal candidate is highly organized, communicates effectively, and can navigate complex payer and hospital requirements.

Key Responsibilities

• Submit and manage electronic applications using the Cactus Credentialing Database
• Follow up with providers to ensure completion of all enrollment documents
• Verify primary source information, including education and work history
• Initiate and track managed care and payer enrollment processes
• Maintain accurate credentialing records in Cactus and Excel
• Interpret payer regulations and resolve credentialing issues as they arise
• Collaborate with internal departments, including Physician Billing and Medical Staff Offices
• Occasionally travel to affiliated sites as needed
• Ensure HIPAA compliance and adherence to hospital policies

Qualifications

• High school diploma required; Associate’s or Bachelor’s degree preferred
• 2–3 years of credentialing or managed care experience preferred
• Familiarity with Cactus or similar credentialing software a plus
• Proficient in Microsoft Word and Excel
• Strong organizational and communication skills
• Ability to interpret complex policies and maintain confidentiality
• NAMSS certification and Notary license a plus, but not required

Physical/Other Requirements

• May require sitting, standing, lifting (up to 25 lbs), and extended computer use
• Flexibility with break/lunch schedules as determined by management