Credentialing & Enrollment Coordinator

PURPOSE: The Jewish Board is a large and diverse human services agency with an annual budget of $240 million 3000 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 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 Boards multiple clinic 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 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) -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 -Departmental Collaboration:Partner with HR Talent Acquisition and Clinical Operations to gather pre-employment documentation reducing time-to-hire by accelerating the credentialing verification 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 softwarespecifically Claude and Microsoft Copilotto summarize changing healthcare regulations draft compliance correspondence and automate administrative 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 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 bythe COMPETENCIES for the position include:Regulatory Knowledge:Deep understanding of US healthcare compliance NCQA standards and government billing Savvy:High flexibility and documented comfort using Tableau for reporting alongside generative A.I. platforms (Claude Microsoft Copilot) to maximize daily workflow REQUIRED:Bachelors 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/LANGUAGE PREFERENCE:Minimum 35 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 SKILLS REQUIRED: Systems Expertise:Mastery of PECOS NPPES CAQH ProView and familiarity with New York State Medicaid / eMedNY / OMH / OASAS provider enrollment registry 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 ENVIRONMENT/PHYSICAL EFFORTConnectivity Requirements:Must possess a reliable high-speed secure internet connection capable of managing heavy digital databases video conferencing and A.I. tools Demands:Prolonged periods of sitting or standing at a desk and working on a computer.

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