Credentialing Specialists / Practice Manager

Job Description Job Description About the Role: We are actively seeking a highly organized and experienced Credentialing Specialist / Practice Manager to join our healthcare team. This unique dual-role position is essential to the operational success and regulatory integrity of our family medicine practice . The ideal candidate will possess extensive CAQH experience , deep knowledge of insurance credentialing, and a proven track record managing the day-to-day functions of a busy outpatient medical practice. This role is ideal for a proactive, detail-driven leader who thrives in a fast-paced environment and values both people management and administrative excellence. Core Responsibilities: Credentialing & Enrollment CAQH Management: Create, update, and maintain provider profiles in the CAQH database. Ensure all required documentation (licenses, certifications, insurance, etc.) is accurate and up to date. Insurance Credentialing & Re-credentialing: Complete applications for payer enrollment, re-enrollment, and re-credentialing. Monitor deadlines and submission timelines to avoid lapses in participation. Payer Communication: Liaise with insurance carriers to track application status, resolve issues, and maintain in-network statuses across commercial and government payers (e.g., Medicare, Medicaid, BCBS, Aetna, etc.). Document Verification: Ensure providers' licenses, DEA, malpractice insurance, and certifications are verified and stored appropriately. Compliance Tracking: Monitor expirations, contract renewals, and regulatory changes to ensure practice remains compliant with all credentialing requirements. Audit Preparation: Maintain organized and audit-ready credentialing records in accordance with state, federal, and insurance policies. Practice / Office Management Daily Operations Oversight: Lead and manage the day-to-day administrative functions of the practice, ensuring efficient workflow, patient satisfaction, and staff coordination. Staff Management: Supervise and support a team of administrative and clinical personnel, including receptionists, medical assistants, and billers. Provide training, delegate tasks, and evaluate performance. Scheduling: Coordinate provider schedules to optimize patient access and reduce inefficiencies in appointment booking. Billing & Revenue Cycle Support: Oversee medical billing, coding, insurance claim submissions, and accounts receivable follow-up. Collaborate with billers or third-party billing services to ensure timely reimbursements. Patient Experience: Foster a welcoming and professional office environment. Resolve escalated patient concerns and improve front-desk and intake processes. Financial Oversight: Manage office budgets, supply inventory, and vendor relationships. Monitor financial KPIs and support practice profitability initiatives. Compliance & Accreditation: Ensure adherence to all local, state, and federal healthcare regulations including HIPAA , OSHA , and CMS requirements. Support quality assurance and accreditation readiness (e.g., NCQA, AAAHC, etc.). Key Skills and Competencies: Exceptional Organizational Skills: Able to manage multiple projects, tight deadlines, and high volumes of documentation without compromising quality or accuracy. Clear Communicator: Professional and effective verbal and written communication with internal staff, providers, insurance companies, and patients. Strong Leadership: Capable of motivating, supervising, and developing staff while maintaining a positive, productive team culture. Tech-Savvy: Proficient in EHR systems (e.g., Athena, eClinicalWorks, Epic), practice management software, Microsoft Office Suite, and credentialing portals. Analytical Thinker: Ability to troubleshoot issues quickly, identify workflow inefficiencies, and develop solutions for administrative and credentialing bottlenecks. Detail-Oriented: Especially critical in credentialing to avoid denials, lapses, or compliance failures. Knowledgeable in Healthcare Finance: Solid understanding of medical billing, CPT/ICD-10 coding, reimbursement models, and payer policies. Required Qualifications: ✅ Minimum 2 years of experience managing a family medicine or primary care practice. ✅ Proven experience with CAQH and health insurance credentialing. ✅ Strong knowledge of medical billing, insurance processes, and healthcare compliance standards. ✅ Demonstrated leadership ability in supervising staff and improving workflows. ✅ Excellent time management, documentation, and multitasking skills. Preferred (But Not Required): Certification in Medical Billing and Coding (e.g., CPC, CPB, CPMSM) Experience with credentialing software (e.g., Modio, Symplr) Familiarity with value-based care programs or PCMH certification Bachelor’s degree in Healthcare Administration, Business, or related field Company Description At Gateway To Life Healing Center, we are your primary healthcare haven, dedicated to guiding you on a journey to vibrant health and well-being. Our team of experienced medical physicians blends traditional wisdom with modern practices to care for your body, mind, and spirit. We believe in the power of personalized primary health care, ensuring each individual's unique needs are met with care and expertise. From pediatrics to senior years, we provide expert care for your family’s health and well-being. Company Description At Gateway To Life Healing Center, we are your primary healthcare haven, dedicated to guiding you on a journey to vibrant health and well-being. Our team of experienced medical physicians blends traditional wisdom with modern practices to care for your body, mind, and spirit. We believe in the power of personalized primary health care, ensuring each individual's unique needs are met with care and expertise. From pediatrics to senior years, we provide expert care for your family’s health and well-being.

Location: Peachtree Corners, GA, US

Posted Date: 4/30/2025