Credentialing & Enrollment Coordinator

PURPOSE:
The Jewish Board is a large and diverse human services agency, with an annual budget of $240 million, 3,000 employees, and 60 service locations around the five boroughs. Our mission is to empower New Yorkers, providing integrated mental health and social services with compassion and expertise.  Our vision is to transform lives and communities through clinical and operational excellence.

POSITION OVERVIEW:

The Credentialing & Enrollment Coordinator manages the end-to-end credentialing, re-credentialing, and payer enrollment processes for all medical and behavioral health providers within The Jewish Board. Operating remotely as an offshore team member based in Mexico, Peru, or Colombia, this role ensures 100% compliance with federal and New York State payer regulations, focusing heavily on PECOS, OPRA, and state mental hygiene frameworks. The Coordinator will leverage artificial intelligence (A.I.) software and advanced databases to optimize tracking, analyze shifting state mandates, and streamline inter-departmental workflows. The individual coordinates closely via digital platforms with New York-based Human Resources, Recruitment, and Program Directors to efficiently onboard new employees, secure necessary working credentials, and safeguard organizational billing relationships across The Jewish Board's multiple clinic locations.

KEY ESSENTIAL FUNCTIONS:

Provider Enrollment & Compliance: Coordinate initial enrollment, revalidation, and maintenance across federal, state, and commercial payers, with expert emphasis on PECOS and OPRA compliance for ordering, prescribing, and referring practitioners.

New York State Regulatory Management: Maintain up-to-date knowledge of New York-specific regulatory bodies to execute precise enrollment workflows through eMedNY (NYS Medicaid), the Office of Mental Health (OMH), and the Office of Addiction Services and Supports (OASAS) portals.

Multi-Specialty Credentialing: Manage the credentialing portfolios for a diverse behavioral health and medical staff, including LCSWs, LMHCs, MDs, PAs, and NPPs, ensuring alignment with New York State Education Department (NYSED) licensing parameters.

Inter-Departmental Collaboration: Partner with HR, Talent Acquisition, and Clinical Operations to gather pre-employment documentation, reducing time-to-hire by accelerating the credentialing verification lifecycle.

Data Visualization & Analytics: Maintain multiple complex databases and use Tableau to design, update, and present clear visual dashboards regarding credentialing pipelines, expiration timelines, and application aging to leadership.

A.I. & Tool Integration: Implement and adapt to generative A.I. productivity software—specifically Claude and Microsoft Copilot—to summarize changing healthcare regulations, draft compliance correspondence, and automate administrative tasks.

Billing Risk Management: Investigate and audit provider enrollment-related claim rejections alongside the billing team; execute data corrections within clearinghouses or state payer registries to minimize revenue leakage.

Primary Source Verification: Execute primary source verifications of state licenses, DEA certificates, malpractice coverage, and education history in strict accordance with NCQA, NYS Department of Health (DOH), and state oversight board guidelines.
Complete other projects assigned by the Senior Director.

CORE COMPETENCIES for the position include:

Regulatory Knowledge: Deep understanding of US healthcare compliance, NCQA standards, and government billing regulations.
Technical Savvy: High flexibility and documented comfort using Tableau for reporting, alongside generative A.I. platforms (Claude, Microsoft Copilot) to maximize daily workflow efficiency.

EDUCATIONAL/TRAINING REQUIRED:

Bachelor’s Degree in Healthcare Administration, Human Services, Business, or a related field preferred (equivalent direct experience fully considered).
Professional Designations: Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) designation is preferred, but not required.

EXPERIENCE REQUIRED/LANGUAGE PREFERENCE:

Minimum 3–5 years of healthcare credentialing and provider enrollment experience, with documented exposure to United States healthcare insurance, behavioral health, mental health clinics, or social services structures.
C1/C2 Professional level written and spoken English to effectively interface with US-based staff, clinicians, and external insurance billing entities.

COMPUTER SKILLS REQUIRED:

Systems Expertise: Mastery of PECOS, NPPES, CAQH ProView, and familiarity with New York State Medicaid / eMedNY / OMH / OASAS provider enrollment registry workflows.

VISUAL AND MANUAL DEXIERITY:

Ability to maintain focus and review high volumes of digital data, regulatory documents, and complex spreadsheets. Must possess the cognitive capacity to multi-task across multiple software platforms and A.I. tools efficiently in a remote setting.

WORK ENVIRONMENT/PHYSICAL EFFORT

Connectivity Requirements: Must possess a reliable, high-speed, secure internet connection capable of managing heavy digital databases, video conferencing, and A.I. tools seamlessly.
Physical Demands: Prolonged periods of sitting or standing at a desk and working on a computer.