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Credentialing Specialist Jobs in Decatur, GA (NOW HIRING)

dekalbcsb

Credentialing Specialist- 130703

Decatur, GA · Hybrid

Credentialing Specialist Location: Claratel Winn Way- 445 Winn Way, Decatur, GA 30030 Hours: Monday - Friday 8:00am- 5:00pm (Hybrid) Claratel Behavioral Health is seeking a dedicated and experienced ...

dekalbcsb

Credentialing Specialist- 130703

Decatur, GA · Hybrid

Credentialing Specialist Location: Claratel Winn Way- 445 Winn Way, Decatur, GA 30030 Hours: Monday - Friday 8:00am- 5:00pm (Hybrid) Claratel Behavioral Health is seeking a dedicated and experienced ...

D4C Dental Brands

Credentialing Specialist

Atlanta, GA · On-site

Description The Credentialing Specialist will be responsible for leading, coordinating, monitoring, and maintaining the credentialing and re-credentialing process. * Liaise between the practitioners ...

EyeSouth Partners

Credentialing Specialist

Atlanta, GA · On-site

Position Summary We are actively recruiting for a Credentialing Specialist to join our growing team at EyeSouth Partners. If you wish to join a growing team with favorable benefits and perks, while ...

EyeSouth Partners

Credentialing Specialist

Atlanta, GA · On-site

Position Summary We are actively recruiting for a Credentialing Specialist to join our growing team at EyeSouth Partners. If you wish to join a growing team with favorable benefits and perks, while ...

Armada Ltd

Credentialing Specialists

Atlanta, GA · On-site

Credentialing Specialists will provide credentialing service and support to operate IRS credentialing sites utilizing the GSA scheduling tool to manage credentialing appointments, run reports through ...

Armada Ltd

Credentialing Specialists

Atlanta, GA · On-site

Credentialing Specialists will provide credentialing service and support to operate IRS credentialing sites utilizing the GSA scheduling tool to manage credentialing appointments, run reports through ...

Armada Ltd

Credentialing Specialists

Atlanta, GA · On-site

Credentialing Specialists will provide credentialing service and support to operate IRS credentialing sites utilizing the GSA scheduling tool to manage credentialing appointments, run reports through ...

Armada Ltd

Credentialing Specialists

Chamblee, GA

Credentialing Specialists will provide credentialing service and support to operate IRS credentialing sites utilizing the GSA scheduling tool to manage credentialing appointments, run reports through ...

Armada Ltd

Credentialing Specialists

Atlanta, GA

Credentialing Specialists will provide credentialing service and support to operate IRS credentialing sites utilizing the GSA scheduling tool to manage credentialing appointments, run reports through ...

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All JobsCredentialing Specialist JobsCredentialing Specialist Jobs in Decatur, GA

Credentialing Specialist information

See Decatur, GA salary details

$13

$23

$38

How much do credentialing specialist jobs pay per hour?

As of Jun 16, 2026, the average hourly pay for credentialing specialist in Decatur, GA is $23.78, according to ZipRecruiter salary data. Most workers in this role earn between $18.80 and $26.97 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a Credentialing Specialist, and why are they important?

To thrive as a Credentialing Specialist, you need a strong understanding of credentialing processes, attention to detail, and familiarity with healthcare regulations, typically supported by a relevant associate’s or bachelor’s degree. Proficiency with credentialing software, databases, and document management systems is commonly required, along with knowledge of standards such as NCQA or Joint Commission. Exceptional organizational skills, effective communication, and the ability to manage deadlines help professionals excel in this role. These competencies ensure accurate provider verification and compliance, which are critical for patient safety and institutional accreditation.

What are some typical challenges a Credentialing Specialist faces when coordinating with healthcare providers and insurance companies?

Credentialing Specialists often encounter challenges such as managing incomplete or inconsistent provider documentation, meeting strict deadlines, and navigating varying requirements from different insurance companies or healthcare facilities. Effective communication and organizational skills are essential, as the role requires frequent follow-up with providers and close coordination with multiple internal departments. Staying updated on regulatory changes and ensuring all files remain compliant can also be demanding but is critical for maintaining smooth healthcare operations.

What do you need to be a credentialing specialist?

To become a credentialing specialist, you typically need a high school diploma or equivalent, with some roles preferring postsecondary education or certifications in healthcare administration or related fields. Strong organizational skills, attention to detail, and familiarity with credentialing processes and healthcare regulations are essential. Experience with databases and credentialing software can also be beneficial.

What are Credentialing Specialists?

Credentialing Specialists are professionals responsible for verifying the qualifications and backgrounds of healthcare providers and ensuring they meet the standards required by hospitals, insurance companies, and regulatory bodies. They collect, review, and process documentation such as licenses, certifications, education, and work history. Their work ensures that only properly qualified professionals are allowed to provide care, helping maintain patient safety and organizational compliance. Credentialing Specialists often work in healthcare facilities, insurance companies, or third-party credentialing organizations.

What Is a Credentialing Specialist?

Credentialing specialists verify the qualifications of the staff in healthcare organizations for healthcare organizations. This verification process ensures that doctors and other medical professionals provide accurate education and work histories, and confirms that they meet all local and federal licensing and regulation requirements before they are hired or contracted with a medical facility. Credentialing specialists are part of an organization's administrative staff; they review medical policies, process contracts, and facilitate audit reports to validate that certified medical professionals comply with credentialing procedures. They also update medical databases with information about a physician’s training or license and document when credentials must be renewed.

What is the difference between Credentialing Specialist vs Medical Biller?

AspectCredentialing SpecialistMedical Biller
Required CredentialsCertification in healthcare credentialing, knowledge of insurance and provider databasesCertification in medical billing, coding, or related areas often preferred
Work EnvironmentHealthcare facilities, insurance companies, or credentialing agenciesMedical offices, billing companies, healthcare providers
Employer & Industry UsageUsed in healthcare to verify provider credentials for insurance and licensingUsed in healthcare to process and submit medical claims for reimbursement

The Credentialing Specialist focuses on verifying healthcare providers' credentials to ensure compliance and eligibility, while the Medical Biller handles billing and claims processing for healthcare services. Both roles are essential in healthcare administration but serve different functions within the industry.

What jobs pay 10,000 a month without a degree?

A Credentialing Specialist typically earns less than $10,000 a month, but some high-paying roles like sales managers, real estate brokers, or certain skilled trades can reach or exceed that level without a degree. These jobs often require experience, certifications, or specialized skills and may involve sales, entrepreneurship, or technical expertise.

What is the role of a credentialing specialist?

A credentialing specialist is responsible for verifying and maintaining the credentials, licenses, and certifications of healthcare providers or other professionals to ensure compliance with industry standards and regulations. They manage documentation, coordinate with licensing boards, and use credentialing software to streamline the process, supporting accurate provider enrollment and accreditation.

Is it hard to become a credentialing specialist?

Becoming a credentialing specialist typically requires attention to detail, organizational skills, and knowledge of healthcare or licensing processes. Many roles require a high school diploma or equivalent, with some employers preferring candidates with certifications or experience in healthcare administration or related fields.
More about Credentialing Specialist jobs
What are the most commonly searched types of Credentialing Specialist jobs in Decatur, GA? The most popular types of Credentialing Specialist jobs in Decatur, GA are:
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What job categories do people searching Credentialing Specialist jobs in Decatur, GA look for? The top searched job categories for Credentialing Specialist jobs in Decatur, GA are:
What cities near Decatur, GA are hiring for Credentialing Specialist jobs? Cities near Decatur, GA with the most Credentialing Specialist job openings:
Credentialing Specialist jobs near you

Credentialing Specialist

Resolve Pain Solutions

Atlanta, GA • On-site

Full-time

Posted 2 days ago

Be an early applicant

Job description

Credentialing Specialist
Position Summary
The Credentialing Manager is responsible for overseeing all provider credentialing, recredentialing, privileging, and enrollment activities across the organization. This role ensures providers are credentialed accurately and timely with all payers, hospitals, and regulatory entities to support uninterrupted patient care and revenue cycle operations. The Credentialing Specialist will lead process improvement initiatives, maintain compliance with regulatory standards, and partner closely with operations, revenue cycle, recruiting, and clinical leadership teams.
Key Responsibilities
Credentialing & Provider Enrollment
  • Manage the full lifecycle of provider credentialing, recredentialing, privileging, and payer enrollment processes for physicians and advanced practice providers.
  • Ensure timely submission and follow-up of applications with commercial payers, Medicare, Medicaid, hospitals, and ancillary facilities.
  • Monitor credentialing expirables including licenses, DEA registrations, board certifications, malpractice insurance, and CME requirements.
  • Maintain accurate provider records within credentialing databases and CAQH profiles.
  • Oversee provider onboarding timelines to ensure providers are credentialed and enrolled prior to start dates whenever possible.
  • Coordinate provider privileging and medical staff applications with hospitals and surgery centers.
Compliance & Quality Assurance
  • Ensure compliance with NCQA, CMS, state, and payer credentialing standards.
  • Develop and maintain credentialing policies, procedures, and audit readiness documentation.
  • Conduct routine audits of provider files and credentialing records.
  • Monitor regulatory changes impacting credentialing and provider enrollment.
Leadership & Operations
  • Establish and track credentialing KPIs such as enrollment turnaround time, application aging, and provider readiness timelines.
  • Collaborate with recruiting and onboarding teams to improve provider start-date readiness.
  • Partner with revenue cycle leadership to minimize delays in billing due to credentialing issues.
  • Identify workflow inefficiencies and implement process improvements and automation opportunities.
Communication & Cross-Functional Partnership
  • Serve as the primary escalation point for credentialing-related issues.
  • Communicate credentialing status updates regularly to operational and executive leadership.
  • Support provider acquisition, expansion, and de novo clinic initiatives through credentialing coordination.
  • Build strong working relationships with payers, hospital systems, and third-party credentialing partners.
Qualifications
Required
  • Bachelor’s degree or equivalent experience preferred.
  • 2-3+ years of provider credentialing experience in healthcare.
  • Strong understanding of payer enrollment, privileging, and credentialing regulations.
  • Experience with Medicare, Medicaid, and commercial payer enrollment processes.
  • Proficiency with credentialing software platforms, CAQH, PECOS, and provider databases.
  • Strong organizational skills with exceptional attention to detail.
  • Ability to manage multiple priorities and deadlines in a fast-paced environment.
Preferred
  • CPCS (Certified Provider Credentialing Specialist) or CPMSM certification.
  • Experience in multi-site physician practice management or healthcare roll-up environments.
  • Familiarity with pain management, surgical, or specialty practice operations.
  • Experience leading credentialing process optimization initiatives.
Key Competencies
  • Operational leadership
  • Process improvement mindset
  • Attention to detail
  • Problem-solving and critical thinking
  • Strong communication and stakeholder management
  • Compliance orientation
  • Ability to work cross-functionally
Success Metrics
  • Reduction in credentialing turnaround times
  • Percentage of providers credentialed before start date
  • Clean application submission rate
  • Reduction in payer enrollment delays impacting billing
  • Compliance audit readiness and accuracy
  • Provider onboarding satisfaction

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