Credentialing Specialist

About Us

Pinnacle Fertility is a leader in physician-centric fertility care, supporting high-performing fertility clinics and comprehensive service providers nationwide. Guided by our mission of fulfilling dreams by building families, Pinnacle offers compassionate care, innovative technology, and comprehensive fertility treatment services to provide patients with a seamless and personalized journey to parenthood. Learn more at www.pinnaclefertility.com.

About the Role

The Credentialing Specialist supports Pinnacle Fertility’s financial performance by ensuring accurate reimbursement, with a strong emphasis on payer enrollment oversight, accuracy, and ongoing maintenance. This role is responsible for monitoring payer and regulatory changes, ensuring providers are correctly enrolled and aligned with payer requirements, and proactively identifying enrollment-related risks that could impact reimbursement or provider readiness.

In addition to conducting payment and fee schedule audits and performing regional fee comparisons, this role provides analytical insights that strengthen payer strategy and reduce preventable denials. The Credentialing Specialist plays a key role in maintaining payer enrollment integrity across the organization and partnering with internal stakeholders to ensure enrollment data, timelines, and requirements are consistently met.

This position also oversees credentialing vendor performance to ensure enrollments are requested and completed in a timely manner and supports payer relationship management, issue resolution, and cross-functional collaboration to ensure compliance with payer rules and evolving regulatory requirements as Pinnacle continues to grow.

We are seeking a Credentialing Specialist to join our dedicated team in Scottsdale, AZ. This is a full-time, onsite position, working Monday through Friday from 8:30 AM to 5:00 PM.

Key Responsibilities

• Conduct detailed payer payment variance audits to identify underpayments and overpayments.
• Analyze trends in payment discrepancies and recommend corrective actions.
• Partner with Payment Posting on corrections, recoveries, and payer escalations.
• Perform fee schedule audits to confirm accurate system loading and appropriate reimbursement.
• Conduct regional fee comparisons across Pinnacle markets to evaluate reimbursement differences and identify opportunities for alignment or negotiation.
• Maintain internal fee schedule documentation and validate updates during payer changes or contract adjustments.
• Support data modeling to identify payer reimbursement gaps or anomalies.
• Monitor payer policy updates, including reimbursement methodologies, coding changes (CPT/HCPCS), modifier rules, and medical necessity edits.
• Assess the operational and financial impact of payer updates and issue timely guidance to Coding, Posting, Denials, and Operations.
• Maintain an internal knowledge base of payer rules and updates.
• Oversee and validate accurate payer enrollment setup and maintenance for new and existing providers to ensure alignment with payer requirements and reimbursement readiness.
• Monitor payer enrollment timelines, status changes, and regulatory requirements, proactively identifying risks that could delay provider start dates or impact revenue.
• Partner cross-functionally to ensure enrollment data is accurate across systems and reflects current payer expectations.
• Oversee credentialing vendor enrollment requests and completions.
• Investigate and resolve enrollment discrepancies, denials, or payer rejections tied to enrollment issues.
• Provide analytical insights to support payer discussions, contract reviews, and strategic initiatives.
• Collaborate with internal teams to ensure payer enrollment, reimbursement, and policy requirements are clearly understood and operationalized.
• Support payer discussions related to enrollment status, discrepancies, and requirements, strengthening external payer relationships and improving resolution timelines.
• Other duties and projects assigned.

Position Requirements

• Education: Bachelor’s degree in healthcare administration, business, or related field preferred; equivalent experience considered.
• Experience: 2-4 years of experience in payer analytics, revenue cycle, reimbursement review, or payer operations, including hands-on experience with payer enrollment processes.
• Skills:
  • Strong analytical skills with the ability to translate data into actionable recommendations.
  • Familiarity with payer enrollment, fee schedules, and reimbursement methodologies.
  • Working knowledge of CPT/HCPCS coding and payer billing rules preferred.
  • Excellent communication skills and ability to collaborate cross-functionally.
  • Experience with fertility, specialty, or outpatient healthcare services preferred.
  • Ability to manage multiple priorities independently in a fast-paced environment.

Compensation & Benefits

• Hourly Rate: $29.00 - $38.00 per hour (final offers based on experience, skills, and qualifications).
• Benefits: Pinnacle Fertility offers a comprehensive benefits package including medical, dental, vision, and life insurance. Additional benefits include generous paid time off, paid holidays, and a retirement savings program. Further details will be provided during the interview process.

Diversity & Inclusivity at Pinnacle Fertility

At Pinnacle Fertility, we are committed to fostering a diverse, inclusive, and welcoming workplace. We are proud to be an equal opportunity employer and encourage applicants of all backgrounds, abilities, and life experiences to apply.