231 credentialing specialist jobs found

Job Title: Credentialing Specialist Location: New York, NY Job Type: Contract Shift: Day Shift (9:00 AM – 5:00 PM) Position Overview We are seeking an experienced Credentialing Specialist to manage and facilitate all aspects of provider credentialing and re-credentialing. This role ensures compliance with regulatory standards while maintaining accurate and up-to-date provider records. The ideal candidate will have strong attention to detail, knowledge of credentialing processes, and experience working within a healthcare setting. Responsibilities Manage the full lifecycle of provider credentialing and re-credentialing Conduct primary source verification for new and existing providers Maintain and update provider files, ensuring accuracy and completeness Monitor credentialing applications and track progress through completion Ensure compliance with regulatory and accrediting agency standards Utilize credentialing software (e.g., MDStaff) to...

Job Title: Credentialing Specialist Location: New York, NY Job Type: Contract Shift: Day Shift (9:00 AM – 5:00 PM) Position Overview We are seeking an experienced Credentialing Specialist to manage and facilitate all aspects of provider credentialing and re-credentialing. This role ensures compliance with regulatory standards while maintaining accurate and up-to-date provider records. The ideal candidate will have strong attention to detail, knowledge of credentialing processes, and experience working within a healthcare setting. Responsibilities Manage the full lifecycle of provider credentialing and re-credentialing Conduct primary source verification for new and existing providers Maintain and update provider files, ensuring accuracy and completeness Monitor credentialing applications and track progress through completion Ensure compliance with regulatory and accrediting agency standards Utilize credentialing software (e.g., MDStaff) to...

We are seeking a Credentialing Specialist with 2 to 5 years of experience to support credentialing and recredentialing operations for a growing health plan. This role will focus on maintaining provider data accuracy, supporting compliance with NCQA standards, understanding state and federal network participation regulations, and ensuring timely, audit - ready credentialing processes. Candidates with experience in NCQA-accredited or certified environments are preferred. salary: $24 - $27 per hour shift: First work hours: 8 AM - 5 PM education: High School Responsibilities Responsibilities Manage credentialing and recredentialing cases in Medallion credentialing platform Review provider files for completeness and identify non-clean cases Summarize gaps, risks, and missing elements for initial credentialing committee review Conduct provider outreach to obtain missing or insufficient information Support roster submissions and validate data accuracy Assist with...

Are you a detail-oriented professional with a passion for compliance and healthcare excellence? We are seeking a disciplined and proactive Credentialing Specialist to join our client's team in the East End. In this role, you will be the guardian of our provider standards, ensuring that every clinician is fully vetted, compliant, and ready to provide care. You’ll be responsible for the primary source verification of healthcare providers, ensuring they are properly enrolled with insurance payers and compliant with all regulatory standards. In a medical billing environment, your accuracy directly impacts the company’s ability to submit claims and get providers paid. Qualifications: 2+ years of experience in healthcare credentialing or medical staff services is preferred. Familiarity with credentialing software and a solid understanding of healthcare accreditation standards The ability to follow up effectively with providers and agencies to keep applications moving forward...

Job Title: Healthcare Credentialing Specialist / Medical Staff Coordinator (Credentialing) Location: New York, NY Shift: Day Shift – 9:00 AM to 5:00 PM Employment Type: Contract (W-2) Pay Rate: $31/hour Job Summary: Seeking an experienced Healthcare Credentialing Specialist to manage and coordinate all aspects of provider credentialing and medical staff services. This role ensures compliance with regulatory standards while maintaining accurate and up-to-date provider records. Key Responsibilities: Manage full-cycle provider credentialing and re-credentialing processes Perform primary source verification for new and existing providers Facilitate provider appointments, reappointments, and clinical privileging Maintain and update physician and provider credentialing files Ensure data accuracy and integrity within credentialing systems Monitor credentialing timelines and compliance with regulatory requirements Conduct credential audits...

Location: Barto, PA 19504 Date Posted: 04/17/2026 Category: Nursing Education: HS Graduate/GED One of our clients is offering client negotiable TEMP TO PERM opportunities at a IDD group home in the Bally/Barto Area! $38+/hour! CLIENT'S AVAILABLE HOURS: Every Monday and Tuesday 8 PM - 8 AM and Every Other Friday 11 PM - 9 AM, Saturday 9 PM - 9 AM, Sunday 9 PM - 9 AM ~OR~ Every Other Friday 11 PM - 9 AM, Saturday 9 PM - 9 AM, Sunday 9 PM - 8 AM SUMMARY OF CLIENT'S DESCRIPTION OF THIS OPPORTUNITY Provide nursing care to individuals with intellectual & developmental disabilities at a group home. Monitor the ongoing health status of patients. Document progress notes. CLIENT'S REQUIRED SKILLS & EXPERIENCE Current & valid LPN License Valid CPR Certification TB Test Physical Child Abuse Clearance Flu Shot Verification Covid Vaccination Card We have a credentialing specialist that can assist you with any of...

Summary This position is eligible for the Education Debt Reduction Program (EDRP), a student loan payment reimbursement program. You must meet specific individual eligibility requirements in accordance with VHA policy and submit your EDRP application within four months of appointment. Program Approval, award amount (up to $200,000) and eligibility period (one to five years) are determined by the VHA Education Loan Repayment Services program office after complete review of the EDRP application. Learn more about this agency This job is open to The public U.S. Citizens, Nationals or those who owe allegiance to the U.S. Federal employees - Competitive service Current federal employees whose agencies follow the U.S. Office of Personnel Management's hiring rules and pay scales. Federal employees - Excepted service Current federal employees whose agencies have their own hiring rules, pay scales and evaluation criteria. Internal...

Summary The United States Department of Labor (DOL), Employment and Training Administration, Chicago Regional Office is recruiting for Unemployment Insurance Program Specialist at the GS-13 level. This position is inside the bargaining unit. Learn more about this agency This job is open to The public U.S. Citizens, Nationals or those who owe allegiance to the U.S. Career transition (CTAP, ICTAP, RPL) Federal employees whose job, agency or department was eliminated and are eligible for priority over other applicants. Clarification from the agency All US Citizens. Interagency Career Transition Assistance Program (ICTAP) and Career Transition Assistance Program (CTAP) eligibles must be in the local commuting area. Also advertised as job# MS-26-DAL-ETA-12936584-KGM (for internal to ETA applicants only). To be considered for each, apply to BOTH jobs. Duties Duties for this position include: Provides authoritative...

The duties that the incumbent of the vacancy will be expected to perform. Duties Description This position will assist the supervisor and staff within the Bureau of Specialized Services for Children (BSSC) in a broad range of planning, implementation, evaluation, and reporting activities. The incumbent will become knowledgeable and develop an understanding of the Children’s Health Home (HHSC) program, the 1915 (c) Children’s Waiver of Home and Community Based Services (HCBS), Children and Family Treatment and Support Services (CFTSS), and Foster Care/29-I services to assist in developing and implementing changes and or enhancements to the services and programs. This position will assist with conducting research, drafting policies and procedures, providing technical assistance to stakeholders, developing public facing guidance documents, assisting with program monitoring and evaluation activities, and maintaining bureau procedures and tracking systems.The incumbent will also assist...

Company : Highmark Inc. Job Description : JOB SUMMARY This job is responsible for developing plans and managing activities in support of Risk Adjustment and Quality/HEDIS. Directs the daily activities of direct reports supporting Risk Adjustment Coding and Quality/HEDIS. Assesses viability of current direction/projects/operations and recommends strategies and tactics to satisfy current and future business needs. Actively seeks and identifies opportunities for improvement. Implements strategic and tactical improvements to the Risk Adjustment Coding and Quality/HEDIS processes. Manages information that will ensure accurate and efficient projects. Responsible for working with appropriate departments in the areas of risk adjustment, compliance, process improvement and member/provider satisfaction for all product lines. Recommend and/or implements process improvements related to the potential of quality medical care and service. Serves as a resource regarding government...

Company : Highmark Inc. Job Description : JOB SUMMARY This job is responsible for developing plans and managing activities in support of Risk Adjustment and Quality/HEDIS. Directs the daily activities of direct reports supporting Risk Adjustment Coding and Quality/HEDIS. Assesses viability of current direction/projects/operations and recommends strategies and tactics to satisfy current and future business needs. Actively seeks and identifies opportunities for improvement. Implements strategic and tactical improvements to the Risk Adjustment Coding and Quality/HEDIS processes. Manages information that will ensure accurate and efficient projects. Responsible for working with appropriate departments in the areas of risk adjustment, compliance, process improvement and member/provider satisfaction for all product lines. Recommend and/or implements process improvements related to the potential of quality medical care and service. Serves as a resource regarding government...

Origami Rehabilitation is a 501(c)(3) nonprofit organization. Origami provides comprehensive rehabilitation for children and adults with neurological, developmental, mental health, and orthopedic conditions through their residential and outpatient programs. With their compassionate and innovative services, Origami creates opportunities and transforms lives.? If you want to make a difference in the lives of our community members through mission-driven work with a close-knit interdisciplinary team, Origami Rehabilitation is the place for you. The Origami team shares the collective goal of exceeding the expectations of our clients. This goal is achieved through a positive growth-mindset, knowledge sharing, and a sincere commitment to growing individually and collectively through collaboration and continued education.?? Origami's core values are Celebrate the Individual, Inspire Excellence, Serve with Integrity, and Lead with Passion. If these values speak to you, please consider...

Company : Highmark Inc. Job Description : JOB SUMMARY This job is responsible for developing plans and managing activities in support of Risk Adjustment and Quality/HEDIS. Directs the daily activities of direct reports supporting Risk Adjustment Coding and Quality/HEDIS. Assesses viability of current direction/projects/operations and recommends strategies and tactics to satisfy current and future business needs. Actively seeks and identifies opportunities for improvement. Implements strategic and tactical improvements to the Risk Adjustment Coding and Quality/HEDIS processes. Manages information that will ensure accurate and efficient projects. Responsible for working with appropriate departments in the areas of risk adjustment, compliance, process improvement and member/provider satisfaction for all product lines. Recommend and/or implements process improvements related to the potential of quality medical care and service. Serves as a resource regarding government...

Company : Highmark Inc. Job Description : JOB SUMMARY This job is responsible for developing plans and managing activities in support of Risk Adjustment and Quality/HEDIS. Directs the daily activities of direct reports supporting Risk Adjustment Coding and Quality/HEDIS. Assesses viability of current direction/projects/operations and recommends strategies and tactics to satisfy current and future business needs. Actively seeks and identifies opportunities for improvement. Implements strategic and tactical improvements to the Risk Adjustment Coding and Quality/HEDIS processes. Manages information that will ensure accurate and efficient projects. Responsible for working with appropriate departments in the areas of risk adjustment, compliance, process improvement and member/provider satisfaction for all product lines. Recommend and/or implements process improvements related to the potential of quality medical care and service. Serves as a resource regarding government...

Company : Highmark Inc. Job Description : JOB SUMMARY This job is responsible for developing plans and managing activities in support of Risk Adjustment and Quality/HEDIS. Directs the daily activities of direct reports supporting Risk Adjustment Coding and Quality/HEDIS. Assesses viability of current direction/projects/operations and recommends strategies and tactics to satisfy current and future business needs. Actively seeks and identifies opportunities for improvement. Implements strategic and tactical improvements to the Risk Adjustment Coding and Quality/HEDIS processes. Manages information that will ensure accurate and efficient projects. Responsible for working with appropriate departments in the areas of risk adjustment, compliance, process improvement and member/provider satisfaction for all product lines. Recommend and/or implements process improvements related to the potential of quality medical care and service. Serves as a resource regarding government...

Company : Highmark Inc. Job Description : JOB SUMMARY This job is responsible for developing plans and managing activities in support of Risk Adjustment and Quality/HEDIS. Directs the daily activities of direct reports supporting Risk Adjustment Coding and Quality/HEDIS. Assesses viability of current direction/projects/operations and recommends strategies and tactics to satisfy current and future business needs. Actively seeks and identifies opportunities for improvement. Implements strategic and tactical improvements to the Risk Adjustment Coding and Quality/HEDIS processes. Manages information that will ensure accurate and efficient projects. Responsible for working with appropriate departments in the areas of risk adjustment, compliance, process improvement and member/provider satisfaction for all product lines. Recommend and/or implements process improvements related to the potential of quality medical care and service. Serves as a resource regarding government...

Company : Highmark Inc. Job Description : JOB SUMMARY This job is responsible for developing plans and managing activities in support of Risk Adjustment and Quality/HEDIS. Directs the daily activities of direct reports supporting Risk Adjustment Coding and Quality/HEDIS. Assesses viability of current direction/projects/operations and recommends strategies and tactics to satisfy current and future business needs. Actively seeks and identifies opportunities for improvement. Implements strategic and tactical improvements to the Risk Adjustment Coding and Quality/HEDIS processes. Manages information that will ensure accurate and efficient projects. Responsible for working with appropriate departments in the areas of risk adjustment, compliance, process improvement and member/provider satisfaction for all product lines. Recommend and/or implements process improvements related to the potential of quality medical care and service. Serves as a resource regarding government...

Company : Highmark Inc. Job Description : JOB SUMMARY This job is responsible for developing plans and managing activities in support of Risk Adjustment and Quality/HEDIS. Directs the daily activities of direct reports supporting Risk Adjustment Coding and Quality/HEDIS. Assesses viability of current direction/projects/operations and recommends strategies and tactics to satisfy current and future business needs. Actively seeks and identifies opportunities for improvement. Implements strategic and tactical improvements to the Risk Adjustment Coding and Quality/HEDIS processes. Manages information that will ensure accurate and efficient projects. Responsible for working with appropriate departments in the areas of risk adjustment, compliance, process improvement and member/provider satisfaction for all product lines. Recommend and/or implements process improvements related to the potential of quality medical care and service. Serves as a resource regarding government...

Company : Highmark Inc. Job Description : JOB SUMMARY This job is responsible for developing plans and managing activities in support of Risk Adjustment and Quality/HEDIS. Directs the daily activities of direct reports supporting Risk Adjustment Coding and Quality/HEDIS. Assesses viability of current direction/projects/operations and recommends strategies and tactics to satisfy current and future business needs. Actively seeks and identifies opportunities for improvement. Implements strategic and tactical improvements to the Risk Adjustment Coding and Quality/HEDIS processes. Manages information that will ensure accurate and efficient projects. Responsible for working with appropriate departments in the areas of risk adjustment, compliance, process improvement and member/provider satisfaction for all product lines. Recommend and/or implements process improvements related to the potential of quality medical care and service. Serves as a resource regarding government...

Company : Highmark Inc. Job Description : JOB SUMMARY This job is responsible for developing plans and managing activities in support of Risk Adjustment and Quality/HEDIS. Directs the daily activities of direct reports supporting Risk Adjustment Coding and Quality/HEDIS. Assesses viability of current direction/projects/operations and recommends strategies and tactics to satisfy current and future business needs. Actively seeks and identifies opportunities for improvement. Implements strategic and tactical improvements to the Risk Adjustment Coding and Quality/HEDIS processes. Manages information that will ensure accurate and efficient projects. Responsible for working with appropriate departments in the areas of risk adjustment, compliance, process improvement and member/provider satisfaction for all product lines. Recommend and/or implements process improvements related to the potential of quality medical care and service. Serves as a resource regarding government...

Company : Highmark Inc. Job Description : JOB SUMMARY This job is responsible for developing plans and managing activities in support of Risk Adjustment and Quality/HEDIS. Directs the daily activities of direct reports supporting Risk Adjustment Coding and Quality/HEDIS. Assesses viability of current direction/projects/operations and recommends strategies and tactics to satisfy current and future business needs. Actively seeks and identifies opportunities for improvement. Implements strategic and tactical improvements to the Risk Adjustment Coding and Quality/HEDIS processes. Manages information that will ensure accurate and efficient projects. Responsible for working with appropriate departments in the areas of risk adjustment, compliance, process improvement and member/provider satisfaction for all product lines. Recommend and/or implements process improvements related to the potential of quality medical care and service. Serves as a resource regarding government...

Summary This position is located in the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), Center for Medicaid and CHIP Services (CMCS). As a Health Insurance Specialist, GS-0107-13, you will serve as an expert in the development, evaluation, and implementation of policies related to Medicaid, Children's Health Insurance Program (CHIP), and Basic Health Program (BHP) policies. Learn more about this agency This job is open to The public U.S. Citizens, Nationals or those who owe allegiance to the U.S. Career transition (CTAP, ICTAP, RPL) Federal employees whose job, agency or department was eliminated and are eligible for priority over other applicants. Duties Identify and propose modifications to Medicaid, CHIP, and BHP program measures, regulations, laws, and policies to reflect changes or trends in the health care industry, program objectives, and the needs of Medicaid, CHIP,...

Company : Highmark Inc. Job Description : JOB SUMMARY This job is responsible for developing plans and managing activities in support of Risk Adjustment and Quality/HEDIS. Directs the daily activities of direct reports supporting Risk Adjustment Coding and Quality/HEDIS. Assesses viability of current direction/projects/operations and recommends strategies and tactics to satisfy current and future business needs. Actively seeks and identifies opportunities for improvement. Implements strategic and tactical improvements to the Risk Adjustment Coding and Quality/HEDIS processes. Manages information that will ensure accurate and efficient projects. Responsible for working with appropriate departments in the areas of risk adjustment, compliance, process improvement and member/provider satisfaction for all product lines. Recommend and/or implements process improvements related to the potential of quality medical care and service. Serves as a resource regarding government...

Company : Highmark Inc. Job Description : JOB SUMMARY This job is responsible for developing plans and managing activities in support of Risk Adjustment and Quality/HEDIS. Directs the daily activities of direct reports supporting Risk Adjustment Coding and Quality/HEDIS. Assesses viability of current direction/projects/operations and recommends strategies and tactics to satisfy current and future business needs. Actively seeks and identifies opportunities for improvement. Implements strategic and tactical improvements to the Risk Adjustment Coding and Quality/HEDIS processes. Manages information that will ensure accurate and efficient projects. Responsible for working with appropriate departments in the areas of risk adjustment, compliance, process improvement and member/provider satisfaction for all product lines. Recommend and/or implements process improvements related to the potential of quality medical care and service. Serves as a resource regarding government...