Credentialing Specialist

This is a fully remote position, open to applicants in Tennessee.

📋 Description

• Review and evaluate initial and reappointment credentialing applications for completeness, accuracy, and compliance.

• Perform primary source verification and gather as well as validate credentialing documents.

• Evaluate the completeness of information and qualifications against credentialing standards.

• Identify, analyze, and address discrepancies, time gaps, and other issues impacting credentialing and enrollment.

• Communicate issues to the Credentialing Manager.

• Stay updated on current health plan and agency credentialing requirements.

• Monitor provider license and certification expirations and assist with prompt renewals.

• Aid in license and DEA registration renewal applications as needed.

• Ensure and maintain enrollment with both contracted and newly contracted health plans.

• Establish and maintain facility affiliations where applicable.

• Seek assistance from payers regarding claims processed out of network.

⛳️ Requirements

• High School Diploma or equivalent is required.

• A minimum of two (2) years of dedicated provider credentialing or provider enrollment experience.

• Proficient understanding of Provider Enrollment portals such as CAQH, NPDB, Identity & Access Management, NPPES, PECOS, and Availity.

• Experience in conducting primary data source verifications.

• Specialized knowledge of the provider credentialing and payer enrollment processes.

• Comprehensive understanding of compliance with state and federal laws, including HIPAA regulations.

• Preferred experience in Facility Credentialing/Medical Staff Services.

• Strong grasp of credentialing processes.

• Keen attention to detail.

• Dedication to supporting high-quality patient care through accurate and timely provider credentialing.

🏝️ Benefits

• Excellent paid time off.

• 401(k) plan with employer matching.

• Education reimbursement opportunities with annual support based on employment status.

• Opportunities for internal growth.

• Support for training and development.

• Competitive health and supplemental benefits.

• FSA and HSA options available.

• Employee referral bonus.