Credentialing Specialist

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.
• Solicit assistance from Payers regarding claims identified by the follow up team as having processed out of network.

What You Bring

• A 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.