Credentialing Specialist

Southern Pediatrics; United States; On-site; USD 50,000 - 70,000; Full time

Job summary

Southern Pediatrics is seeking a Credentialing Specialist to manage the end-to-end credentialing lifecycle for pediatric providers, including initial credentialing, ongoing maintenance, and enrolling providers to new Tax ID Numbers after acquisitions.

The role requires tracking licensure, certifications, DEA registrations, and payer enrollments, and serving as the point of contact for providers and payers to resolve enrollment issues. Experience with CAQH, PECOS, NPPES, and Availity is preferred.

Qualifications

• Minimum education: high school education or GED required.
• Experience: minimum of two years of provider credentialing and payer enrollment experience; pediatrics or primary care and acquisitions experience preferred.

Responsibilities

• Manage the end-to-end credentialing and re-credentialing process for an assigned caseload of providers (MDs, NPs), supported by credentialing software
• Complete initial credentialing and payer enrollment for new providers to ensure timely participation across Medicaid/TennCare and commercial plans
• Maintain active credentials by tracking and renewing licenses, board certifications, DEA registrations, and payer enrollments prior to expiration
• Enroll providers to Southern Pediatrics’ Tax ID Numbers (TINs) following acquisitions to ensure continuity of participation and reimbursement
• Submit and follow up on initial and revalidation applications to Medicaid and commercial payers
• Obtain and maintain hospital privileges as clinically appropriate
• Maintain accurate provider profiles and track application status, expirables, and caseload progress in credentialing software (e.g., CAQH, PECOS, NPPES, Availity)
• Serve as the point of contact for providers, payers, and internal teams to resolve credentialing and enrollment issues, and terminate enrollments upon provider departure
• Follow Company policies, procedures, and operational guidelines, including completing required training and adopting new skills, technologies, or systems that are introduced to support patient care and business needs

Skills

Credentialing processes

Payer enrollment

Communication

Time management

Caseload management

Education

High school diploma or GED

Tools

CAQH

PECOS

NPPES

Availity

Job description

The Credentialing Specialist supports patient access and revenue integrity by ensuring all providers are properly credentialed and enrolled with Medicaid and commercial payers. This position manages the end-to-end credentialing lifecycle for an assigned caseload of pediatric providers, including initial credentialing of new providers, ongoing maintenance of active credentials, and enrolling providers to new Tax ID Numbers (TINs) following practice acquisitions. This position reports to the Revenue Cycle Manager.

POSITION RESPONSIBILITIES

This position has a variety of job responsibilities, and the Company reserves the right to add or modify the job duties at any time based on the needs of the business and patient care. Fundamental to this position is maintaining active credentials and payer enrollments so providers can deliver care without interruption. Below lists out the primary job responsibilities:

• Manage the end-to-end credentialing and re-credentialing process for an assigned caseload of providers (MDs, NPs), supported by a leading credentialing software platform
• Complete initial credentialing and payer enrollment for all newly hired providers to ensure timely participation across Medicaid/TennCare and commercial plans
• Maintain active credentials by tracking and renewing licenses, board certifications, DEA registrations, and payer enrollments prior to expiration to prevent lapses
• Enroll providers to Southern Pediatrics’ Tax ID Numbers (TINs) following acquisitions, ensuring continuity of participation and reimbursement with minimal disruption
• Submit and follow up on initial and revalidation applications to Medicaid and commercial payers
• Obtain and maintain hospital privileges as clinically appropriate
• Maintain accurate provider profiles and track application status, expirables, and caseload progress in credentialing software (e.g., CAQH, PECOS, NPPES, Availity), escalating at-risk items
• Serve as the point of contact for providers, payers, and internal teams to resolve credentialing and enrollment issues, and terminate enrollments upon provider departure
• Follow Company policies, procedures, and operational guidelines, including completing required training and adopting new skills, technologies, or systems that are introduced to support patient care and business needs

POSITION QUALIFICATIONS

Below represents the intended qualifications for employees with this position:

• Minimum education: high school education or GED required
• Experience: minimum of two years of provider credentialing and payer enrollment experience required; experience in pediatrics or primary care, and with acquisitions and Tax ID (TIN) enrollments, is preferred

POSITION SKILLS

To be successful in this position, employees must demonstrate a diversity of skills related to credentialing, accuracy, and communication. Below are some of those skills:

• Strong understanding of the end-to-end credentialing and enrollment process for pediatric providers across commercial plans and Medicaid (including TennCare)
• Familiarity with credentialing systems and payer portals, including CAQH, PECOS, NPPES, and Availity
• Proficiency using credentialing software to track licenses, expirables, application status, and caseload
• Ability to manage a high-volume caseload and meet productivity and turnaround targets
• Strong time management, attention to detail, and effective written and verbal communication

OUR MISSION AND VALUES

All positions at Southern Pediatrics are expected to represent and embody our mission and values:

Our mission

Southern Pediatrics exists to accelerate access to comprehensive care so all children have the opportunity to thrive.

Our values

we have three values, our ABCs – Action-oriented, always accountable; Boundless moves, bold hearts; Compassion in every connection.