Credentialing Specialist

One GI, LLC•Germantown, TN

2d•Onsite

About The Position

One GI® is seeking a well-versed Credentialing Specialist to join their growing team. The ideal candidate brings strong knowledge of credentialing processes, attention to detail, and a commitment to supporting high-quality patient care through accurate and timely provider credentialing. One GI® is a true collaboration of top-tier clinical and business professionals, united by a shared focus on what matters most: our patients. Every team member plays a vital role, and your contributions will make a meaningful impact.

Requirements

High School Diploma or equivalent required
Minimum of two (2) years focused provider credentialing or provider enrollment experience.
Working knowledge of Provider Enrollment portals including but not limited to CAQH, NPDB, Identity & Access Management, NPPES, PECOS, and Availity.
Experience in performing primary data source verifications.
Specific knowledge of provider credentialing and payer enrollment process.
Thorough knowledge of compliance with state and federal laws, including HIPAA, required.

Nice To Haves

Facility Credentialing/ Medical Staff Services experience, preferred.

Responsibilities

Review and screen initial and reappointment credentialing applications for completeness, accuracy, and compliance with federal, state, and local regulations, guidelines, policies, and standards.
Conduct primary source verification, collect, and validate documents to ensure accuracy of all credentialing elements; assess completeness of information and qualifications relative to credentialing standards.
Identify, analyze, and resolve information, discrepancies, time gaps and other idiosyncrasies that could adversely impact ability to credential and enroll practitioners; discover and convey problems to Credentialing Manager.
Maintain knowledge of current health plan and agency requirements for credentialing providers.
Track license and certification expirations for all providers to ensure timely renewals and assists in submitting license and DEA registration renewal applications where desired.
Assist in securing and maintaining enrollment with currently contracted plans as well as newly contracted plans upon identification.
Assist in securing and maintaining facility affiliation where appropriate.
Seek assistance from Payers regarding claims identified by the follow up team as having processed out of network.
Thorough knowledge of compliance with state and federal laws, including HIPAA, required.