Provider Credentialing & Enrollment 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

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.