Medical Credentialing Specialist

CAROLINA NEPHROLOGY, PA; Greenville (SC); On-site; USD 34,000 - 37,000; Full time

Benefits offered by this job

Competitive pay

Growing nephrology org

Collaborative environment

Job summary

Carolina Nephrology, PA is seeking an experienced Medical Credentialing Specialist to manage provider credentialing across ambulatory centers and hospitals. You will handle CAQH, payer enrollment, and re-credentialing for 20–40 providers.

Proficiency with Qgenda or similar software is required, along with strong organizational skills and attention to detail to ensure compliance with regulatory standards and timely credentialing approvals.

Qualifications

• Experience in healthcare credentialing across multiple provider settings.
• Strong proficiency with Qgenda or similar credentialing software.
• Knowledge of CAQH management and payer enrollment processes.
• Thorough understanding of credentialing regulations and accreditation standards.

Responsibilities

• Manage initial credentialing and re-credentialing for 20–40 providers across ambulatory surgery centers, hospitals, dialysis centers, and clinics.
• Oversee payer enrollment and re-enrollment activities with Medicare, Medicaid, and commercial plans.
• Maintain provider information within CAQH and other credentialing databases.
• Coordinate credentialing with 7–12 hospitals, dialysis organizations, and 20–25 clinic locations.
• Ensure facility credentialing and regulatory compliance.

Skills

Healthcare credentialing

Payer enrollment

CAQH management

QGenda software

Tools

QGenda

Job description

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.

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.

Description

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 managing 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.

Requirements

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