Credentialing Specialist
Excelsior Orthopaedics·Eggertsville, New York
Excelsior Orthopaedics·Eggertsville, New York
The specialist is responsible for managing all aspects of credentialing, re-credentialing, and privileging for clinical team members, ensuring providers are properly credentialed with health plans and facilities. Duties include maintaining accurate provider data in databases, tracking license renewals, and preparing application packets for various entities.
Demonstrate our core values of being patient centered, team focused, service driven, accountable, and innovative every day. Compile and maintain accurate, up-to-date credentialing data for all providers. Complete credentialing and re-credentialing applications; monitor application status and follow up as needed. Maintain copies of current state licenses, Drug Enforcement Administration (DEA) certificates, malpractice coverage, and other required credentialing documents. Manage and update corporate provider contract files. Stay current on health plan and agency credentialing requirements. Establish and maintain provider information within online credentialing databases and systems. Track license and certification expiration dates to ensure timely renewals. Verify and update practice addresses with health plans, agencies, and other entities. Audit health plan directories to ensure provider information is accurate and up to date. Prepare and submit credentialing and re-credentialing application packets for hospitals, insurance carriers, and government programs. Apply for National Provider Identifier (NPI) numbers for new providers; provide NPI information to physician offices and insurance carriers as needed. Establish new and maintain existing provider information in Council for Affordable Quality Healthcare (CAQH) by following established guidelines. Initiate malpractice coverage applications for new providers. Coordinate with Accounts Payable to ensure timely payment of fees for licenses, DEA certificates, and malpractice coverage. Monitor and maintain a database of Continuing Medical Education (CME) credits and additional certifications earned by providers. Maintain confidentiality of all provider information. Provide credentialing and privileging verification as requested. Strong knowledge and understanding of the credentialing process. Ability to organize and prioritize work effectively and manage multiple priorities. Strong research and data analysis skills. Ability to work independently with minimal supervision. Excellent interpersonal skills with the ability to build and maintain positive working relationships with providers, management, staff, and external contacts. Evolve in your role when performing supplemental responsibilities as assigned. QualificationsRequirements and Qualifications Associates degree preferred; HS diploma or GED required. Certified Provider Credentialing Specialist (CPCS) preferred. Minimum 2 years’ experience as a Credentialing Specialist or in a similar role required. Demonstrated knowledge with EMR systems (e.g. Medent, Epic, or similar) is required. Comprehensive knowledge of medical practice software programs, credentialing requirements of hospitals, malpractice insurance coverages and policies and insurance carries preferred. Computer skills required with minimum proficiency in Microsoft Word, Excel, Outlook, and Teams. Physical Demands Manual and finger dexterity and eye-hand coordination to enter data and operate office equipment. Corrected vision and hearing within normal range to observe and communicate with patients, providers, and staff. Frequently remaining in a stationary position, often sitting for prolonged periods working on a computer, telephone, copy/fax machine, and other office equipment. Occasional standing and walking required. Occasional lifting and carrying items weighing up to 10 pounds. The pay range for this position is determined based on several factors, including the candidate’s years of experience, qualifications, training, licenses, designations, and the overall market conditions. This job description does not state or imply that the duties and responsibilities listed are the only ones required of this position. Team members in this role will be required to perform other job-related duties at the discretion of the employer and may have additional duties assigned as necessary. Excelsior Orthopaedics and Buffalo Surgery Center are committed to the full inclusion of all applicants. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity, national origin, veteran status, or genetic information.
A minimum of two years of experience as a Credentialing Specialist or in a similar role is required, along with demonstrated knowledge of EMR systems. An Associate's degree is preferred, and a Certified Provider Credentialing Specialist (CPCS) certification is preferred.
Market context
Support-services roles in New York are often tied to hospitals, labs, and education systems that need dependable operational support and compliance-minded staff. Competition can be strong because employers may prefer candidates with some lab or research exposure plus transferable skills, and this platform’s AI-summarized job requirements and benefits help you review the original posting faster. If you are applying, match your education and any hands-on lab, research, or coordination experience directly to the listed requirements.