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firstPRO 360

Provider Credentialing Specialist

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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. Key Responsibilities 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.