Credentialing Specialist

5 days ago


New York, New York, United States Momentum Resource Solutions Full time
Job Summary

Momentum Resource Solutions is seeking a skilled Credentialing Coordinator to join our team. As a Credentialing Coordinator, you will play a critical role in ensuring the accuracy and completeness of provider credentialing information.

Key Responsibilities
  • Establish and maintain effective communication with credentialing contacts at facilities and provider sites to coordinate the receipt of necessary information for credentialing, re-credentialing, and updates to provider credentialing information.
  • Review provider-credentialing files for completion and present them to the Credentialing Committee.
  • Perform primary source verification on required elements and adhere to MetroPlus' policies and procedures.
  • Enter and maintain provider information in the credentialing database.
  • Verify New York State OPMC and Medicare/Medicaid for any current sanctions, restrictions on licensure, and/or limitations on the scope of practice on all credentialed providers during interim credentialing periods.
  • Generate and disseminate monthly provider credentialing updates to relevant departments at Health Plan and participating facilities and providers.
  • Create, copy, file, and maintain all relevant documentation in provider credentialing folders.
  • Perform annual delegated file audits and participate in pre-delegation and delegation site reviews.
  • Respond to inquiries from other departments regarding a provider's credentialing status.
  • Perform other related tasks as directed by the Director of Provider Services and the Credentialing Manager.


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