Credentialing Specialist

One GI®; Germantown (TN); On-site; USD 42,000 - 64,000; Full time

Benefits offered by this job

Paid time off

401(k) match

Education reimbursement

Career growth

Benefits + FSA/HSA

Referral bonus

Job summary

One GI® in Germantown, TN seeks a Credentialing Specialist to join our team. You will review credentialing applications, perform primary source verifications, and ensure compliance with federal, state, and local regulations to support accurate provider enrollment.

Your role requires sharp attention to detail, familiarity with CAQH, NPDB, Availity, and related enrollment portals, and the ability to work with HIPAA guidelines while supporting timely credentialing for our providers.

Qualifications

• Two years of focused provider credentialing or provider enrollment experience.
• Knowledge of credentialing processes and related regulations (federal, state, local).
• Experience with primary data source verifications.
• Familiarity with Provider Enrollment portals CAQH, NPDB, Availity, etc.
• HIPAA compliance knowledge.

Responsibilities

• Review and screen initial and reappointment credentialing applications for completeness, accuracy, and regulatory compliance.
• Conduct primary source verification and collect/validate documents for accuracy of credentialing elements.
• Identify and resolve information gaps and discrepancies affecting credentialing and enrollment.
• Maintain knowledge of current health plan and agency requirements for credentialing providers.
• Track license and certification expirations to ensure renewals and assist in renewal submissions when needed.
• Assist in securing and maintaining enrollment with contracted plans and new plans.
• Assist in securing facility affiliation where appropriate.
• Seek assistance from payers regarding out-of-network claims as identified by follow-up.
• Ensure compliance with state and federal laws including HIPAA.

Skills

Attention to detail

Credentialing knowledge

Education

High School Diploma or equivalent

Tools

CAQH

NPDB

Identity & Access Management

NPPES

PECOS

Availity

Job description

Credentialing Specialist, OneGI

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!

We are currently seeking a well-versed Credentialing Specialist to join our 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.

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.