Job Purpose: As a Credentialing Specialist at Denova Collaborative Health, you will play an essential role in managing provider enrollment, re-enrollment, and revalidation with government and commercial health plans. Your work will support timely provider activation, billing readiness, regulatory compliance, and seamless patient care.

This position primarily focuses on Payor Enrollment, with additional responsibilities supporting credentialing and provider record management.

This is a non-exempt position reporting to the Credentialing Supervisor.

What You Will Do: 

• Prepare, submit, and manage provider enrollment, re-enrollment, and revalidation applications with Medicare, Medicaid, and commercial health plans.
• Monitor application statuses, follow up with payers, and resolve enrollment delays, discrepancies, and outstanding requirements.
• Maintain accurate provider information in CAQH, PECOS, payer portals, and internal tracking systems.
• Coordinate provider additions, terminations, demographic updates, and payer roster changes.
• Track enrollment approvals, effective dates, and revalidation deadlines to support timely provider activation and billing.
• Collaborate with providers, Revenue Cycle Management, billing, and internal departments to resolve enrollment-related issues.
• Support credentialing and re-credentialing activities, including verification of licenses, certifications, malpractice coverage, DEA/NPI information, and other required documentation.
• Maintain accurate enrollment and credentialing records in accordance with payer, regulatory, and accreditation requirements.
• Support audits, compliance reviews, NHSC documentation, and process improvement initiatives, as applicable.
• Perform additional related duties as 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.
• Minimum of 1 year of hands-on provider or payer enrollment experience required.
• Experience preparing, submitting, and tracking enrollment applications with government or commercial health plans required.
• Familiarity with Medicare, Medicaid, commercial payer enrollment, re-enrollment, and revalidation processes.
• Knowledge of CAQH, PECOS, NPI, DEA, and credentialing requirements preferred.
• Strong organizational skills, attention to detail, and ability to manage multiple deadlines.
• Excellent communication and problem-solving skills with the ability to work effectively with payers, providers, and internal teams.
• Proficiency with Microsoft Office, payer portals, and web-based systems

Your Work Schedule:

• Location: Denova Headquarters
• Full-Time: Monday to Friday, 8:00 AM – 5:00 PM
• First 90 Days: Onsite training and onboarding.
• After 90 Days: Hybrid schedule with required onsite presence on Wednesdays and additional onsite days as needed, based on performance and 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.
• 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.