Company Overview Orthopaedic Associates of Duluth, P.A. (OA) has been serving the Northland community since 1969, providing comprehensive orthopedic and sports medicine healthcare. Our dedicated team of medical professionals offers a full spectrum of treatment and rehabilitation services aimed at restoring mobility and reducing pain, ensuring patients can return to their active lifestyles swiftly and safely. Job Summary We are seeking a detail-oriented and proactive Credentialing Specialist to join our healthcare team. The ideal candidate will possess strong administrative skills within a healthcare setting, with expertise in managing provider credentials, insurance processes, and data entry. This role is vital in ensuring our providers meet all licensing, certification, and insurance requirements to facilitate seamless patient care and billing operations. Essential Duties and Responsibilities Provider Credentialing & Enrollment Coordinate the initial credentialing, recredentialing, and enrollment of physicians, physician assistants, nurse practitioners, and other licensed providers. Prepare, submit, and monitor credentialing and enrollment applications with commercial insurance carriers, Medicare, Medicaid, workers' compensation carriers, and other governmental and private payers. Complete provider enrollment and participation applications for new providers and practice locations. Track application status and proactively follow up with payers to ensure timely processing. Maintain provider participation with all contracted insurance plans. Provider Records Management Maintain accurate and current credentialing files for all providers.

Verify and maintain current:

Medical licenses DEA registrations Board certifications Professional liability insurance

BLS/ACLS

certifications (as applicable) Continuing education documentation National Provider Identifier (NPI) information Curriculum vitae Hospital privileges Monitor expiration dates and coordinate timely renewals to prevent lapses in provider eligibility. CAQH & Regulatory Compliance Ensure ongoing compliance with regulatory requirements according to NCQA accreditation standards. Maintain and attest provider profiles within CAQH. Maintain provider information within PECOS, NPPES, Availity, and payer credentialing portals as applicable. Ensure compliance with CMS, payer, state licensing, and regulatory credentialing requirements. Maintain audit-ready credentialing documentation. Secure confidential information shared between committees, departments, administration, and Board of Directors. Hospital & Ambulatory Surgery Center Credentialing Coordinate hospital medical staff applications, reappointments, and privileging. Maintain provider privileges with affiliated hospitals and Ambulatory Surgery Centers (ASCs). Ensure providers meet all facility-specific credentialing requirements prior to providing patient care. Coordinate onboarding requirements for new providers with facility partners. Provider Onboarding & Offboarding Coordinate credentialing activities for newly hired providers to support timely patient scheduling and billing. Assist providers in obtaining NPIs, DEA registrations, and other required credentials when applicable. Coordinate termination notifications and payer updates when providers separate from the organization. Communication & Collaboration Serve as the primary point of contact for providers regarding credentialing status and requirements. Collaborate with Human Resources, Revenue Cycle, Practice Leadership, Clinical Operations, and Billing to ensure credentialing activities support organizational operations. Develop positive working relationships with payer representatives, hospital credentialing departments, and regulatory agencies. Reporting & Process Improvement Maintain credentialing reports and tracking logs. Monitor credentialing timelines and identify upcoming renewal deadlines. Recommend workflow improvements to increase efficiency and reduce credentialing delays. Assist with credentialing audits and regulatory surveys. Document Management Receive patient records from business partners in the form of fax, mail, and email sources. Scan paper records and index electronic documents into patient's chart on OA's EMR. Ensure documents are available in a timely manner. Maintain complete and accurate patient records. Create appointments for outreach clinic patients. Assist with scheduling and pre-registration tasks. Qualifications Required Associate degree or equivalent combination of education and experience. Minimum of 3 years of healthcare credentialing, provider enrollment, medical staff services, or healthcare administration experience. Experience with Medicare, Medicaid, and commercial payer enrollment. Experience maintaining provider credentialing records. Working knowledge of healthcare regulatory requirements related to credentialing. Strong organizational skills with exceptional attention to detail. Ability to manage multiple projects and deadlines simultaneously. Excellent written and verbal communication skills. Proficiency in Microsoft Office applications. Preferred Bachelor's degree in Healthcare Administration, Business Administration, or a related field. Experience in orthopedic, surgical, or multispecialty medical practices. Experience with CAQH, PECOS, NPPES, Availity, and commercial payer portals. Experience coordinating hospital and Ambulatory Surgery Center privileging. Experience working with electronic medical record systems. Certification through the National Association Medical Staff Services (NAMSS), such as CPCS or CPMSM. Knowledge, Skills & Abilities Thorough understanding of provider credentialing and payer enrollment processes. Knowledge of CMS, commercial payer, and regulatory credentialing requirements. Ability to interpret credentialing guidelines and payer requirements. Strong analytical and problem-solving skills. Exceptional attention to detail and accuracy. Ability to maintain confidentiality and handle sensitive information. Excellent customer service and relationship-building skills. Ability to work independently while collaborating effectively across departments. Performance Expectations Successful performance in this role includes: Credentialing and enrollment activities are completed accurately and within required timelines. Provider credentialing files remain complete, accurate, and audit-ready. Provider licensure, certifications, and payer enrollments remain current without lapse. New providers are credentialed in a timely manner to support patient access and reimbursement. Strong working relationships are maintained with providers, payers, hospitals, and surgery center partners. Opportunities to improve credentialing workflows and operational efficiency are identified and implemented. Physical Requirements Prolonged periods of sitting and computer use. Frequent use of standard office equipment. Ability to occasionally lift up to 20 pounds.

Pay Scale:

$23.73-$29.71/hour Orthopaedic Associates is proud to be an Equal Opportunity Employer. We are committed to providing equal employment opportunities and maintaining a workplace free from discrimination and harassment. Employment decisions are made without regard to any status protected by federal, state, or local law.

Pay:

$23.73 - $29.71 per hour

Benefits:

401(k) Dental insurance Flexible spending account Health insurance Health savings account Life insurance Paid time off

Work Location:

In person