Job Description
Description Job Purpose: As a Credentialing Specialist at Denova Collaborative Health, you will play a key role in supporting provider readiness, compliance, and operational success by ensuring providers, clinicians, facilities, and payer records are properly credentialed and maintained. This role helps ensure our teams can continue delivering quality, integrated care while meeting payer, licensing, regulatory, and accreditation requirements.
This is an non-exempt position reporting to the Credentialing Supervisor.
What You Will Do:
- 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.
What We Need From You:
- High school diploma or equivalent required; associate or bachelor's degree in healthcare administration, business, or a related field preferred.
- At least 1 year of administrative, credentialing, healthcare, compliance, payer enrollment, or related experience required.
- 1-3 years of credentialing, provider enrollment, payer enrollment, or healthcare compliance experience preferred.
- 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.
- Knowledge of CAQH, NPI, DEA, payer enrollment, licensing, and credentialing documentation requirements is preferred.
Your Work Schedule:
- This role is based at our Headquarters location.
- Monday - Friday, 8:00 AM - 5:00 PM.
- This position offers a hybrid work arrangement, with in-office presence on Wednesdays and additional onsite days based on business needs.
Perks of Being Part of Denova:
- 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
- Enjoy holiday pay, PTO, and life insurance benefits.
- Protect your future with long and short-term disability options.
- We offer an employee wellness program and fantastic discounts for all Denova team members.
- And there's so much more waiting for you!
Denova Collaborative Health LLC is an integrated primary care and behavioral health practice based in the Greater Phoenix metropolitan area. Our comprehensive virtual care services are available for residents throughout the entire state of Arizona.
We provide a "whole person" approach to health and promote collaboration among our team of primary care providers and specialists. Our unique service integration of primary care, behavioral health, addiction medicine, and wellness enables our team to provide better health outcomes.
Job Tags
Temporary work, Work at office, Monday to Friday