Credentialing Specialist

One GI; Forest Hill (TN); On-site; USD 36,000 - 48,000; Full time

Benefits offered by this job

Excellent paid time off

401(k) plan with employer match

Education reimbursement opportunities

Internal growth opportunities

Competitive health and supplemental…

Refer a friend bonus

Job summary

One GI is seeking a Credentialing Specialist to review credentialing and enrollment applications and perform primary source verifications. The role requires attention to detail and experience with CAQH, NPDB, Availity and related portals.

Join a team focused on high standards of compliance and patient care, with opportunities for professional growth and a strong benefits package. This on-site role supports various provider networks and health plans.

Qualifications

• 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 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.

Responsibilities

• Review and screen initial and reappointment credentialing applications for completeness, accuracy, and compliance with regulations and standards.
• Conduct primary source verification and validate documentation for accuracy.
• Identify and resolve information gaps that could affect credentialing and enrollment.
• Maintain knowledge of current health plan and agency requirements for credentialing providers.
• Track license and certification expirations and assist in renewals and DEA registrations when needed.
• Assist in securing and maintaining enrollment with contracted plans.

Skills

Credentialing knowledge

Primary source verification

Attention to detail

Communication

Education

High School

Tools

CAQH

NPDB

Identity & Access Management

NPPES

PECOS

Availity

Job description

Job Details

Job Location: TN 3085 Fountainside Dr 0VQ53 - Germantown, TN 38138

Education Level: High School

Travel Percentage: None

Job Category: Admin - Clerical Credentialing Specialist, OneGI

Why Join Us

Are you looking to join a company that values respect, integrity, accountability, and leadership? Do you want to be part of one of the nation’s leading providers of gastroenterology care? If so, One GI® may be the place for you—come join our family!

Who We Are

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.

Awesome Perks, Just for You!

• Excellent paid time off for a healthy work/life balance.
• We’ve got your future in mind! With our generous 401(k) plan, we’ll help you grow your nest egg with an employer match that makes saving for retirement even sweeter.
• Looking to further your education? We want to help! We offer education reimbursement opportunities, with generous annual support based on your employment status.
• Internal growth opportunities. We want to aide in your training and development.
• Competitive health and supplemental benefits; with FSA and HSA options.
• Love where you work? Spread the word! Refer a friend who’d be a great fit for One GI® and earn a special bonus when they join the team!

What you will do:

• 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.

What you bring:

• 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
• Facility Credentialing/ Medical Staff Services experience, preferred.

Qualifications

Qualifications