Responsibilities
- Prepare, submit, and track credentialing and re-credentialing applications for providers, clinicians, facilities, private payers, managed care organizations, and other applicable entities.
- Support credentialing processes for physicians, nurse practitioners, physician assistants, clinical therapists, and other healthcare professionals.
- Collect, verify, and maintain provider documentation, including licenses, certifications, malpractice coverage, DEA/NPI information, education, training, work history, and other required records.
- Ensure credentialing files are complete, accurate, current, and compliant with federal, state, payer, licensing, and accreditation standards.
- Monitor expiration dates and proactively follow up on renewals for licenses, certifications, payer enrollments, insurance, and other required documentation.
- Maintain accurate credentialing databases, trackers, rosters, and provider records to support reporting, audit readiness, and timely updates.
- Communicate regularly with providers, internal departments, leadership, payers, and external agencies to obtain required information and resolve credentialing or enrollment issues.
- Assist with payer enrollment, provider roster updates, and follow-up needed to support timely billing and provider activation.
- Maintain NHSC-related information and documentation, as applicable.
- Support internal audits, compliance reviews, and process improvement efforts related to credentialing and provider enrollment.
- Other duties as identified or assigned.
Requirements
- High school diploma or equivalent
- At least 1 year of administrative, credentialing, healthcare, compliance, payer enrollment, or related experience
- Strong attention to detail and accuracy when reviewing, entering, and maintaining information.
- Excellent written and verbal communication skills with the ability to work professionally with providers, leaders, payers, and internal teams.
- Strong organizational and time management skills with the ability to manage multiple deadlines and follow-up items.
- Ability to work independently while also collaborating with cross-functional teams.
- Proficiency with Microsoft Office products, including Outlook, Word, and Excel.
- Ability to use computers, web-based systems, payer portals, credentialing platforms, and other online tools.
Nice to Have
- Associate or bachelor’s degree in healthcare administration, business, or a related field
- 1–3 years of credentialing, provider enrollment, payer enrollment, or healthcare compliance experience
- Knowledge of CAQH, NPI, DEA, payer enrollment, licensing, and credentialing documentation requirements
Benefits
- Comprehensive low-cost medical, dental, and vision insurance.
- Generous retirement plan with a 3.5% company match.
- Secure your future with both long and short-term disability options.
- Holiday pay, PTO, and life insurance benefits.
- Employee wellness program and fantastic discounts for all Denova team members.
Work Arrangement
Hybrid
Additional Information
- This position offers a hybrid work arrangement, with in-office presence on Wednesdays and additional onsite days based on business needs.
