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HealthfirstHE

Credentialing Specialist

Healthfirst is a not-for-profit health insurer based in New York, providing a range of affordable health plans and emphasizing community health.

Healthfirst

Employee count: 1001-5000

AU, CA + 4 more

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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.

About the job

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Job type

Full Time

Experience level

Education

High school
Bachelor degree

Hiring timezones

United States +/- 0 hours, and 5 other timezones

About Healthfirst

Learn more about Healthfirst and their company culture.

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Healthfirst has been a dedicated partner in providing affordable healthcare solutions to New Yorkers for over 30 years. Founded by a coalition of leading hospitals, we have created a model that focuses on transitioning the healthcare system towards value-based care—where the quality of care is prioritized over volume. Our extensive network includes nearly 2 million members across New York City and beyond, encompassing a variety of products such as Medicaid, Medicare Advantage, Child Health Plus, and Essential Plans. With a commitment to enhancing healthcare access and outcomes, we offer comprehensive services that include individualized care coordination, tailored health plans for all ages, and many community health initiatives.

At Healthfirst, we place significant emphasis on community engagement, driving efforts to partner with local organizations to ensure that healthcare reaches those who need it most. Our dedicated workforce is more than just an insurance provider; we serve as proactive allies in the health journey of our members. This includes providing essential resources for managing long-term health conditions, access to necessary screenings, and supportive services that encourage healthy lifestyles. As part of our mission, we actively seek to eliminate barriers to healthcare, ensuring every member can access the benefits and services they deserve, thereby promoting overall wellness and longevity in the communities we serve.

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Healthfirst

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