Job Description

The Provider Data Management and Credentialing Specialist is responsible for ensuring the data integrity for contracted providers. This includes ongoing audit of the provider database, monitoring provider sanctions from regulatory agencies, participation status with payer programs, and other demographic and credentialing and contractual requirements. This individual is responsible for timely and accurate data reporting to management, payers and other business partners.

1. Conducts analysis on data integrity across the departments multiple processes such as Credentialing and Provider Data Management activity.

2. Participates in ongoing sanctions monitoring process for contracted providers in the organization (i.e., FEHBP, OIG, OPMC, etc.).

3. Participates in department activity for any payer initiatives related to provider data veracity and exchange.

4. Participates in project implementation of major changes to the departments processes.

5. Participates in ongoing department process improvement initiatives.

6. Performs related duties and special projects, as assigned.

7. Maintains patient/employee confidentiality in the management of information

8. Observes Mount Sinai Health System compliance policies

9. Implements and maintains established Health Care System policies and procedures.

10. Verifies with multiple primary sources organizations (i.e., New York State DOE, NPDB, ABMS, OIG, etc.) providers status during initial credentialing and recredentialing cycles.

11. Communicates with providers to obtain requisite information to facilitate timely processing and follows up on inquiries from providers, internal departments or payers related to the credentialing processes/data.

12. Coordinates credentialing related data/profiles with various sources (i.e., internal departments, provider groups, etc.) to support credentialing delegated arrangements.

13. Other duties as assigned

• Bachelors Degree or combination of education and equivalent business experience.
• 2 years minimum in credentialing.
• 2 years minimum in provider operations.

Non-Bargaining Unit, E01 - Partner MSO Services - MSH, Mount Sinai Hospital

Strength through Unity and Inclusion

The Mount Sinai Health System is committed to fostering an environment where everyone can contribute to excellence. We share a common dedication to delivering outstanding patient care. When you join us, you become part of Mount Sinai’s unparalleled legacy of achievement, education, and innovation as we work together to transform healthcare. We encourage all team members to actively participate in creating a culture that ensures fair access to opportunities, promotes inclusive practices, and supports the success of every individual.

At Mount Sinai, our leaders are committed to fostering a workplace where all employees feel valued, respected, and empowered to grow. We strive to create an environment where collaboration, fairness, and continuous learning drive positive change, improving the well-being of our staff, patients, and organization. Our leaders are expected to challenge outdated practices, promote a culture of respect, and work toward meaningful improvements that enhance patient care and workplace experiences. We are dedicated to building a supportive and welcoming environment where everyone has the opportunity to thrive and advance professionally. Explore this opportunity and be part of the next chapter in our history.

About the Mount Sinai Health System:

Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, with more than 48,000 employees working across eight hospitals, more than 400 outpatient practices, more than 300 labs, a school of nursing, and a leading school of medicine and graduate education. Mount Sinai advances health for all people, everywhere, by taking on the most complex health care challenges of our time — discovering and applying new scientific learning and knowledge; developing safer, more effective treatments; educating the next generation of medical leaders and innovators; and supporting local communities by delivering high-quality care to all who need it. Through the integration of its hospitals, labs, and schools, Mount Sinai offers comprehensive health care solutions from birth through geriatrics, leveraging innovative approaches such as artificial intelligence and informatics while keeping patients’ medical and emotional needs at the center of all treatment. The Health System includes more than 9,000 primary and specialty care physicians; 13 joint-venture outpatient surgery centers throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and more than 30 affiliated community health centers. We are consistently ranked by U.S. News & World Report's Best Hospitals, receiving high "Honor Roll" status, and are highly ranked: No. 1 in Geriatrics, top 5 in Cardiology/Heart Surgery, and top 20 in Diabetes/Endocrinology, Gastroenterology/GI Surgery, Neurology/Neurosurgery, Orthopedics, Pulmonology/Lung Surgery, Rehabilitation, and Urology. New York Eye and Ear Infirmary of Mount Sinai is ranked No. 12 in Ophthalmology. U.S. News & World Report’s “Best Children’s Hospitals” ranks Mount Sinai Kravis Children's Hospital among the country’s best in several pediatric specialties. The Icahn School of Medicine at Mount Sinai is ranked No. 11 nationwide in National Institutes of Health funding and in the 99th percentile in research dollars per investigator according to the Association of American Medical Colleges. Newsweek’s “The World’s Best Smart Hospitals” ranks The Mount Sinai Hospital as No. 1 in New York and in the top five globally, and Mount Sinai Morningside in the top 20 globally.

Equal Opportunity Employer

The Mount Sinai Health System is an equal opportunity employer, complying with all applicable federal civil rights laws. We do not discriminate, exclude, or treat individuals differently based on race, color, national origin, age, religion, disability, sex, sexual orientation, gender, veteran status, or any other characteristic protected by law. We are deeply committed to fostering an environment where all faculty, staff, students, trainees, patients, visitors, and the communities we serve feel respected and supported. Our goal is to create a healthcare and learning institution that actively works to remove barriers, address challenges, and promote fairness in all aspects of our organization.

Compensation

The Mount Sinai Health System (MSHS) provides salary ranges that comply with the New York City Law on Salary Transparency in Job Advertisements. The salary range for the role is $58661 - $74250 Annually. Actual salaries depend on a variety of factors, including experience, education, and operational need. The salary range or contractual rate listed does not include bonuses/incentive, differential pay or other forms of compensation or benefits.

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