Provider Credentialing Specialist

Job Description

Job Description

firstPRO 360 is assisting our client in the Sandy Springs client seeking Provider Credentialing Specialist. In this role you will be responsible for managing provider credentialing, recredentialing, payer enrollment, and privileging processes for providers and an Ambulatory Surgery Center (ASC). Ensures credentials, licenses, and payer information remain accurate, current, and compliant.

• Manage provider credentialing, recredentialing, payer enrollment, and hospital privileges.
• Maintain accurate provider information across internal systems, CAQH, health plans, and credentialing databases.
• Track and renew licenses, DEA certificates, malpractice coverage, certifications, and other required documents.
• Ensure provider and practice information is accurate with payers and regulatory agencies.
• Monitor health plan directories and resolve provider listing discrepancies.
• Maintain payer contacts and support fee schedule updates.
• Review EOBs and denial trends related to credentialing and enrollment.
• Stay current with payer, regulatory, and agency requirements.
• Support billing, insurance, and credentialing-related projects as needed.

Qualifications

• High school diploma or equivalent; Associate degree preferred.
• 2+ years of provider credentialing or enrollment experience.
• Medical billing and insurance follow-up experience preferred.
• Experience with eClinicalWorks preferred.
• Strong knowledge of credentialing, payer enrollment, CAQH, and medical billing processes.
• Excellent organizational, communication, analytical, and problem-solving skills.
• Highly detail-oriented and able to manage multiple priorities independently.
• Proficient in Microsoft Office and online credentialing systems.

firstPRO 360 is a professional recruitment firm that has been providing talented professionals with opportunities since 1986. We invest in building relationships with people and businesses to benefit the communities that we live and work in.

Our success is built on a foundation of absolute integrity and the highest dedication to providing value both within and beyond our organization.

Company Description

firstPRO 360 is a professional recruitment firm that has been providing talented professionals with opportunities since 1986. We invest in building relationships with people and businesses to benefit the communities that we live and work in. \r\n\r\nOur success is built on a foundation of absolute integrity and the highest dedication to providing value both within and beyond our organization.