Provider Enrollment & Credentialing Specialist

Pinnacle Wound Management-posted 22 days ago
Full-time • Entry Level
Gainesville, GA
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At Pinnacle Wound Management, we are dedicated to improving the lives of patients through high-quality wound care delivered by expert physicians, nurse practitioners, and physician assistants. As a growing leader in this specialized healthcare field, we’re looking for a detail-oriented and proactive Provider Enrollment & Credentialing Specialist to support our expanding clinical team. The Provider Enrollment & Credentialing Specialist will be responsible for the full-cycle credentialing and enrollment of our healthcare providers, including physicians and mid-level practitioners. This role is vital to ensuring that our clinical staff are enrolled with payers, credentialed with facilities, and compliant with all regulatory and operational standards.

  • Manage the credentialing and re-credentialing processes for physicians, nurse practitioners, and physician assistants.
  • Enroll new providers with Medicare, Medicaid, and commercial insurance plans.
  • Maintain accurate and up-to-date provider information in internal databases and with payer systems.
  • Track expirables (e.g., licenses, certifications, malpractice insurance) and ensure timely renewals.
  • Communicate with providers and internal departments to gather necessary documentation and resolve enrollment or credentialing issues.
  • Monitor and respond to payer requests and follow up to ensure timely processing.
  • Stay current on enrollment and credentialing regulations and payer requirements.
  • Support facility privileging processes when applicable.
  • 2+ years of experience in healthcare credentialing and/or provider enrollment.
  • Familiarity with CAQH, PECOS, NPPES, and commercial insurance enrollment processes.
  • Strong organizational skills and attention to detail.
  • Ability to work independently and manage multiple tasks and deadlines.
  • Excellent communication skills, both written and verbal.
  • Experience in wound care or with mobile healthcare providers is a plus.
  • Knowledge of credentialing software and platforms.
  • Experience working with a geographically distributed provider team.
  • Understanding of state licensing requirements and compliance standards.
  • Opportunity to be part of a mission-driven team making a direct impact on patient care.
  • Supportive and collaborative work environment.
  • Competitive salary and benefits package.
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