The Bridge offers supportive housing and behavioral health services to vulnerable New Yorkers facing behavioral health and substance use challenges. We provide individuals with the tools they need to pursue their dreams and live meaningful lives. The Bridge envisions a world where adults experiencing serious mental illness can live and thrive within their communities. As a recognized leader in developing and operating supportive housing and community-based programs, The Bridge has 70 years of experience helping New Yorkers with mental illness, including those affected by homelessness, incarceration, and institutionalization. 

Scope of Position: The Credentialing Coordinator plays a key role in supporting our healthcare providers by managing the credentialing process to ensure they meet both regulatory and organizational standards. You will be responsible for processing provider enrollments and renewals, as well as maintaining up-to-date credentialing records. In addition, you will oversee billing for key programs, ensuring submissions are accurate and timely. This role requires strong attention to detail and effective communication with internal teams and external stakeholders to resolve any credentialing or billing issues. By handling these essential tasks, you will help ensure smooth operations and compliance, contributing to the overall success of our programs and services. 

Essential Position Functions:

• Process agency-wide provider and agency enrollment, credentialing, and revalidation through eMedNY, PECOS, Availity, and CAQH.
• Verify that healthcare professionals' licenses, credentials, and qualifications are valid, up-to-date, and meet both regulatory and organizational standards.
• Maintain comprehensive records of credentialing activities, including applications, verifications, and accreditation documentation.
• Provide guidance on renewal dates for licenses and credentials to ensure timely compliance.
• Work closely with providers to offer advice on credentialing requirements and compliance.
• Respond to inquiries and facilitate communication to resolve credentialing issues promptly.
• Stay updated on medical policies, local licensing, and certification requirements.
• Collaborate with healthcare professionals and other stakeholders to ensure ongoing compliance with credentialing standards.
• Prepare and maintain detailed reports on credentialing activities and updates.
• Assist auditors with credentialing activities and documentation.
• Manage payer credentialing, renewals, provider roster updates, and practice information requests.
• Effectively handle clearinghouse claims issues and ensure their resolution.
• Analyze and report on accounts receivable, including any discrepancies or issues.
• Research, investigate, and resolve complex claims issues, ensuring clear communication throughout the process.
• Perform other tasks as assigned by the supervisor.

• High school diploma or equivalent required.
• Associate’s degree in healthcare services, health information management, or related field preferred; or a certificate from a technical school for billing.
• Certification as a Certified Biller or Certified Provider Credentialing Specialist is preferred.
• Certificate/Diploma or proven knowledge in Medical Reimbursement and Coding.
• 3-5 years of experience in healthcare billing and credentialing.
• Strong understanding of Managed Care Payer rules and Medicare LCD and NCCI Edits.
• Knowledge of OMH and OASAS regulations and procedures.
• Familiarity with Medicare and CMS Behavioral Health guidance.
• Experience with third-party payer, Medicaid, and Medicare billing and payment procedures.
• Understanding of the Provider Credentialing process and Medicaid Excess Income procedures.
• Familiarity with Not-for-profit and Behavioral Health regulations.
• Proficient in the use of computer systems.
• Knowledge of NYS ePaces, eMedNY, CMS PECOS, and NGS; experience with Availity and AWARDS is a plus.
• Strong interpersonal skills for effective communication and troubleshooting with program personnel and insurance plan contacts.
• Ability to establish and maintain effective working relationships.
• Strong research and data analysis abilities.
• Ability to work independently and manage tasks efficiently.

The Bridge Inc. is an Affirmative Action / Equal Opportunity Employer