Medical Credentialing Specialist

CAROLINA NEPHROLOGY, PA; Greenville (SC); On-site; USD 52,000 - 56,000; Full time

Benefits offered by this job

401(k)

Dental insurance

Health insurance

Life insurance

Paid time off

Vision insurance

Job summary

Carolina Nephrology is seeking an experienced Medical Credentialing Specialist to manage credentialing, privileging, and payer enrollment across multiple settings, with strong proficiency in Qgenda or similar software.

Responsibilities include initial and re-credentialing for 20–40 providers across ambulatory surgery centers, hospitals, dialysis centers, and clinics, coordinating with 7–12 hospitals and 20–25 clinics, ensuring CAQH updates and regulatory compliance.

Qualifications

• Experience in healthcare credentialing, payer enrollment, facility credentialing, and CAQH management.
• Strong working knowledge of QGenda or similar credentialing software.
• Credentialing across hospitals, ASCs, dialysis facilities, and physician practices.
• Thorough understanding of credentialing regulations and payer requirements.

Responsibilities

• Manage initial credentialing and re-credentialing for 20–40 providers across multiple sites.
• Oversee payer enrollment and re-enrollment with Medicare, Medicaid, and commercial plans.
• Maintain and update CAQH and credentialing databases.
• Coordinate credentialing with 7–12 hospitals, dialysis organizations, and 20–25 clinics.

Skills

Credentialing experience

Payer enrollment

CAQH management

Regulatory awareness

Tools

QGenda

Job description

Position Overview

Carolina Nephrology is seeking an experienced Medical Credentialing Specialist. The ideal candidate will have extensive experience managing provider credentialing in a multi-provider healthcare environment and possess strong proficiency with Qgenda or similar credentialing software. This individual will play a key role in ensuring providers maintain compliance with all credentialing, privileging, and payer enrollment requirements across multiple healthcare settings.

Key Responsibilities

• Manage the initial credentialing and re-credentialing processes for 20–40 providers across ambulatory surgery centers, hospitals, dialysis centers, and outpatient clinics.
• Oversee payer enrollment and re-enrollment activities, including Medicare, Medicaid, and commercial insurance plans.
• Maintain and update provider information within CAQH and other credentialing databases.
• Coordinate credentialing and privileging activities with 7–12 hospitals, multiple dialysis organizations, and 20–25 clinic locations.
• Manage facility credentialing and ensure organizational compliance with regulatory and accreditation requirements.
• Monitor credentialing expiration dates and proactively manage renewals to prevent lapses in provider participation.
• Collaborate with physicians, administrators, practice leadership, and external organizations to facilitate timely credentialing approvals.
• Maintain accurate credentialing records and ensure compliance with federal, state, payer, and organizational standards.

Qualifications

• Demonstrated experience in healthcare credentialing, payer enrollment, facility credentialing, and CAQH management.
• Strong working knowledge of QGenda or similar credentialing software is required.
• Experience credentialing providers across multiple healthcare environments, including hospitals, ASCs, dialysis facilities, and physician practices.
• Thorough understanding of credentialing regulations, accreditation standards, and payer requirements.
• Exceptional organizational, time-management, and communication skills.
• Strong attention to detail and ability to manage multiple projects and deadlines simultaneously.
• Ability to work independently while maintaining a high level of accuracy and accountability.

What We Offer

• Competitive compensation based on experience and qualifications.
• Opportunity to support a growing, provider-focused nephrology organization.
• Collaborative and professional working environment.

Benefits

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Hours: Monday-Friday 9am-5pm

Pay: $25.00 - $27.00 per hour

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