Credentialing Specialist - Hybrid Atlanta, GA (Tues-Thurs)

Gentiva•Atlanta, GA

7d•Hybrid

About The Position

The Credentialing Specialist oversees payer credentialing and enrollment for Nurse Practitioners with Medicare, Medicaid, and commercial insurance payers. The role manages initial enrollment, recredentialing, and ongoing maintenance of network participation; prepares, submits, and tracks enrollment applications; and maintains provider records in CAQH, PECOS, NPPES, and applicable Medicaid systems. The specialist serves as a liaison among payers, Nurse Practitioners, Revenue Cycle, Compliance, and other internal departments. The role monitors application statuses, effective dates, and revalidation deadlines; resolves enrollment issues that may delay billing or reimbursement; coordinates provider onboarding and offboarding; and maintains accurate credentialing records. The position also supports regulatory compliance, staff meetings, process improvement initiatives, and assigned projects. This is a safety-sensitive position. The role is hybrid in Atlanta, Georgia, with work on Tuesday through Thursday indicated.

Requirements

Excellent data processing skills and expert knowledge of Microsoft Excel.
Strong computer skills and ability to work with multiple online and computer applications.
Flexible and efficient time management skills and ability to prioritize workload.
Good decision-making and analytical problem-solving skills.
Ability to perform repetitive tasks with a high degree of accuracy.
Ability to work with confidential information.
Excellent verbal and written communication skills.
Detail- and deadline-oriented work ethic, with ability to prioritize and multitask.
Bachelor’s degree or equivalent work experience.
Minimum 3–5 years of data processing experience, preferably in a healthcare, compliance, or legal environment.

Nice To Haves

Familiarity with CHAPS and ACHC credentialing standards.
Experience with Dayforce/Ceridian or similar HR or credentialing software.
Prior healthcare credentialing experience.
Experience supporting physician onboarding and offboarding in a compliance setting.

Responsibilities

Oversee and manage payer credentialing and enrollment for Nurse Practitioners with Medicare, Medicaid, and commercial insurance payers.
Manage initial provider enrollment, recredentialing, and ongoing maintenance of Nurse Practitioner participation in payer networks.
Prepare, submit, and track payer enrollment applications, ensuring timely approvals and accurate provider information.
Maintain and update provider records in CAQH, PECOS, NPPES, and applicable Medicaid enrollment systems.
Serve as a liaison among insurance payers, Nurse Practitioners, Revenue Cycle, Compliance, and other internal departments.
Monitor payer enrollment statuses, effective dates, revalidation deadlines, and outstanding applications to prevent billing and reimbursement delays.
Communicate with insurance payers to resolve enrollment delays, application discrepancies, and credentialing issues.
Coordinate Nurse Practitioner onboarding and offboarding, including payer enrollment, group affiliations, and provider terminations.
Maintain accurate provider credentialing records, including licenses, NPI numbers, DEA registrations, certifications, and payer participation information.
Collaborate with Revenue Cycle and Billing teams to resolve payer enrollment issues affecting claims processing and reimbursement.
Ensure compliance with Medicare, Medicaid, commercial payer requirements, and applicable federal and state regulations.
Participate in administrative staff meetings, process improvement initiatives, and special projects as assigned.
Perform other related duties as assigned.

Benefits

Competitive pay.
401(k) with company match.
Career advancement opportunities.
National and local recognition programs.
Teammate Assistance Fund.
Medical, dental, and vision insurance for full-time associates.
Mileage reimbursement or fleet vehicle program for full-time associates.
Generous paid time off and 7 paid holidays for full-time associates.
Wellness programs, including telemedicine, diabetes management, and Joint & Spine Concierge Care, for full-time associates.
Education support and tuition assistance for full-time associates.
Free continuing education units (CEUs) for full-time associates.
Company-paid life and long-term disability insurance for full-time associates.
Voluntary benefits, including pet, critical illness, accident, and long-term care coverage, for full-time associates.