Credentialing Specialist - Hybrid; Tues-Thurs

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.

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.

Benefits for All Associates (Full-Time, Part-Time & Per Diem):

Competitive Pay 401(k) with Company Match Career Advancement Opportunities National & Local Recognition Programs Teammate Assistance Fund

Additional Full-Time Benefits:

Medical, Dental, Vision Insurance Mileage Reimbursement or Fleet Vehicle Program Generous Paid Time Off + 7 Paid Holidays Wellness Programs (Telemedicine, Diabetes Management, Joint & Spine Concierge Care) Education Support & Tuition Assistance Free Continuing Education Units (CEU) Company-paid Life & Long-Term Disability Insurance Voluntary Benefits (Pet, Critical Illness, Accident, LTC)

• 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

At Gentiva, it is our privilege to offer compassionate care in the comfort of wherever…