Payer Credentialing Specialist

Pinnacle GI Partners is a family of gastroenterology practices. We strive to differentiate our practices with a world-class patient experience, bringing together a remarkable network of skilled physicians with top-notch equipment, facilities, and opportunities to collaborate as professionals.

We are in search of a Payer Credentialing Specialist to join our Shelby Twp team. This role is responsible for managing the payer credentialing process from start including obtaining applications from the payers, completing applications, submitting applications timely per policy or within a reasonable time frame to avoid delays, complete regular follow up with the payers to ensure applications are being processed, and obtaining contracts once the credentialing process is completed. The Payer Credentialing Specialist reports to the Revenue Cycle Manager.

Some of your responsibilities in this role will be:

• Manages the payer credentialing process from start to finish including obtaining applications from the payers, completing applications accurately, submitting applications timely per policy or within a reasonable time frame to avoid delays, complete regular follow up with the payers to ensure applications are being processed, and obtaining contracts once the credentialing process is completed.
• Completes, updates and maintains Council for Affordable Quality Healthcare (“CAQH”) profiles for providers. Properly maintain files on each provider, items may include (CAQH, CV, certifications, licenses, malpractice files, hospital privileges, etc.)
• Creates urgency with providers and facilities via email and phone to encourage timely and accurate document submission by establishing target dates and monitoring document submission progress.
• Works directly with administrative contacts and customers which includes performing regular updates and communicating clearly on the status of the enrollment process to customers and contacts as designated by the customer, or manager on a regular basis.
• Maintains a company wide data source for all participating and non-participating providers with payer identification numbers and effective dates.
• Serves as a change agent; recommends improvements and efficiencies and assists team members to embrace change.
• Assists with the implementation of the orientation program for new employees and continuing education for established employees.
• Maintains the confidentiality of patients, physicians and staff.
• Maintains open and positive communication with all personnel.
• Participates in organizational committees as assigned.
• Accepts additional responsibilities as assigned by the Revenue Cycle Manager.

What we are looking for in a candidate:

• Must possess a comprehensive knowledge of payer credentialing, as normally obtained through a bachelor’s degree (or sufficient work experience to waive) in Business or Healthcare Administration or a related field and 3 years' experience in payer enrollment.
• Superior customer service skills. Strong technological skills with the ability to make recommendations and implement new technical solutions.
• Strong interpersonal skills – team player who is able to prioritize multiple responsibilities, manage a large workload within tight deadlines – works well under pressure and consistently meets deadlines, readily adapts to change and excels in a productivity-based environment.
• High level of professionalism and communication skills to interact with physicians, ACPs, employees at all levels, and vendors.
• Must be authorized to work in the US
• Must be able to pass a background check and drug screen upon hire.

What we offer:

• Competitive pay rates
• Paid time off
• Paid holidays, plus two additional paid floating holidays in 2025
• Medical, Dental, and Vision insurance, with the option for voluntary Life & Disability benefits, that begin on the 1st of the month after hire date with us
• 401(k) retirement plan with company match (90-day waiting period applies)

About Pinnacle GI Partners

Pinnacle GI Partners is a gastrointestinal health company. Pinnacle GI Partners is a proud Equal Employment Opportunity Employer that participates in E-Verify.

Founded in 2020 and headquartered in Rochester, Michigan, Pinnacle GI Partners offers patients comprehensive GI services encompassing general and sub-specialty gastroenterology, colorectal surgery, endoscopic surgery centers, infusion services, anesthesiology and pathology.

Our vision is to lead the way in gastrointestinal care. We aim to partner with physicians throughout the US to support them in providing great patient care within their communities, to ensure access to the leading edge of clinical practice and research, and to enable a more connected and caring patient experience.

Our model builds on the legacies of our partner practices and is focused on building a platform for the next generation of physicians to support GI care in their communities

Our company maintains substantial physician ownership and is backed by HIG Growth Partners, a leading US-based private equity investment firm with extensive experience in building highly successful healthcare companies.