Payor Credentialing Specialist at Crouse Hospital – Syracuse, New York

Since 1887, Crouse Health has been a leading healthcare provider in Central New York. We’ve combined a family-friendly culture with a passion to provide the best care, which creates an environment where both patients and team members feel valued. Crouse Health offers a full range of general and specialty care, inpatient and outpatient services, as well as community health education and outreach programs.

Crouse’s Medical Staff Administration team is hiring a Payor Credentialing Specialist to credential all newly hired clinicians (MD, NP, PA) with all participating insurers for Crouse Hospital and Crouse Medical Practice.

Pay Range: $65,000.00 - $80,000.00 / annual

Schedules: Monday-Friday, 8:00am-4:30pm

Payor Credentialing Specialist Position Responsibilities:

• Credential newly hired clinicians with applicable insurance payers for timely billing.
• Collect, Submit, & Track all necessary documentation.
• Process re-credentialing for existing clinicians as required by individual payers.
• Maintain a current, accurate database of all clinicians’ credentialing / licensure status, needs, expirations, issues, etc. Share with internal staff as applicable.
• Communicate & Coordinate with all levels of internal staff & external stakeholders to ensure timely & consistent qualification is met & maintained.
• Monitor expiring credentials to ensure ongoing compliance with regulatory guidelines.
• Investigate and resolve any issues that arise during the approval process.
• Under the direction of leadership, assist with site level enrollments or changes to contract.
• Other duties as deemed necessary.
• Assumes other duties as assigned by department leadership.

Payor Credentialing Specialist Position Requirements:

• High School Diploma or GED required, Bachelor’s Degree preferred.
• Minimum of 2 years' experience in provider enrollment required.
• Knowledge of Medicare, Medicaid & third-party provider enrollment processes.
• Strong understanding of managed care processes.
• Experience working in a medical office or healthcare setting.
• Familiarity with medical terminology and its application in credentialing.
• Previous experience with NCQA standards or similar accreditation processes.
• Professional written and verbal communication and interpersonal skills.
• Excellent organizational skills with a keen eye for detail.
• Ability to communicate effectively with diverse stakeholders
• Proficiency in Microsoft Office and EMR systems, EPIC preferred.
• Proficiency in CAQH, PECOS & NPPES preferred.

Benefits Overview:

• Medical, Dental, Vision, FSA, and 401K.
• Company paid life insurance.
• Tuition Assistance and Workforce Development Opportunities.
• Crouse Health Employee Assistance Program.
• Employee discounts on any Inpatient or Outpatient service, hospital cafeteria and pharmacy, and certain retailers.
• YMCA Subsidy program.