| Location | Atlanta, GA |
Overview
Ensure Compliance. Maintain Accuracy. Support Healthcare Excellence.
As a Credentialing Specialist, You Will:
Oversee and manage all aspects of payer credentialing and enrollment for Nurse Practitioners (NPs), including Medicare, Medicaid, and commercial insurance payers.
Manage initial provider enrollment, recredentialing, and ongoing maintenance of NP participation with insurance payer networks.
Prepare, submit, and track payer enrollment applications, ensuring timely approvals and accurate provider information.
Maintain and update provider records in CAQH, PECOS, NPPES, and applicable Medicaid enrollment systems.
Serve as a liaison between insurance payers, Nurse Practitioners, Revenue Cycle, Compliance, and other internal departments.
Monitor payer enrollment statuses, effective dates, revalidation deadlines, and outstanding applications to prevent billing and reimbursement delays.
Communicate directly with insurance payers to resolve enrollment delays, application discrepancies, and credentialing issues.
Coordinate onboarding and offboarding of Nurse Practitioners, including payer enrollment, group affiliations, and provider terminations.
Maintain accurate provider credentialing records, including licenses, NPI numbers, DEA registrations, certifications, and payer participation information.
Collaborate with Revenue Cycle and Billing teams to resolve payer enrollment issues impacting claims processing and reimbursement.
Ensure compliance with Medicare, Medicaid, commercial payer requirements, and applicable federal and state regulations.
Participate in administrative staff meetings, process improvement initiatives, and special projects as assigned.
Perform other related duties as assigned.
About You
Qualifications - What You'll Bring:
Excellent data processing skills with expert knowledge of Microsoft Excel.
Strong computer skills and able to work with multiple online and computer applications.
Demonstrates flexible and efficient time management and ability to prioritize workload.
Good decision-making and analytical problem-solving skills.
Able to work on repetitive tasks with a high degree of accuracy.
Ability to work with confidential information.
Excellent verbal and written communication skills.
Detail- and deadline-oriented work ethic with the ability to prioritize and multi-task.
Bachelor's degree or equivalent work experience.
Minimum 3-5 years of data processing experience, preferably in a healthcare, compliance, or legal environment.
Preferred Qualifications (Not Required):
Familiarity with credentialing standards of CHAPS and ACHC.
Experience with Dayforce/Ceridian or similar HR/credentialing software.
Prior healthcare credentialing experience.
Experience supporting physician onboarding/offboarding in a compliance setting.
We Offer
Benefits for All Associates (Full-Time, Part-Time & Per Diem):
Additional Full-Time Benefits:
Apply today and help maintain compliance and excellence in credentialing that supports quality patient care.
Legalese
This is a safety-sensitive position
Employee must meet minimum requirements to be eligible for benefits
Where applicable, employee must meet state specific requirements
We are proud to be an EEO employer
We maintain a drug-free workplace
ReqID: 2026-144216 Category: Corporate Position Type: Full-Time Company: Gentiva