Provider Credentialing & Compliance Specialist

Pride Health; Charlotte (NC); On-site; USD 50,000 - 70,000; Full time

Benefits offered by this job

Comprehensive healthcare coverage

401(k)-retirement savings

Life & disability insurance

Employee discounts with preferred vendors

Job summary

A healthcare organization in Charlotte, North Carolina is seeking a detail-oriented Provider Credentialing Specialist. This role involves overseeing internal processes and regulatory compliance related to provider enrollment and credentialing. The preferred candidate will have a minimum of 3 years of experience in a healthcare setting, strong knowledge of credentialing processes, and excellent organizational skills. The organization offers comprehensive healthcare coverage and additional benefits to eligible employees.

Qualifications

• Minimum 3 years of experience in provider credentialing, privileging, or enrollment.
• Experience in healthcare, hospital, managed care, or RCMS environment.
• Strong knowledge of credentialing processes and compliance requirements.

Responsibilities

• Oversee internal processes related to provider enrollment and credentialing.
• Ensure timely and accurate completion of provider applications.
• Support departmental planning, development, and organization.

Skills

Organizational skills

Communication skills

Problem-solving skills

Data management

Regulatory compliance

Time management

Education

High School Diploma or GED

Bachelor’s degree in Healthcare Administration, Business Administration or related field

Tools

Microsoft Office (Word, Excel)

Credentialing systems/databases

Job description

We are seeking a detail-oriented Provider Credentialing Specialist to oversee internal processes, regulatory compliance, and governmental requirements related to provider enrollment and credentialing. This role ensures the timely and accurate completion of provider applications while supporting departmental planning, development, and organization.

Required Qualifications

• High School Diploma or GED
• Minimum 3 years of experience in:
• Provider credentialing, privileging, or enrollment
• Healthcare, hospital, managed care, or RCMS environment
• Strong knowledge of:
• Credentialing processes and compliance requirements
• Microsoft Office (Word, Excel)
• General office equipment (copiers, fax machines, multi-line phones)
• Excellent organizational, communication, and problem-solving skills

Preferred Qualifications

• Bachelor’s degree in Healthcare Administration, Business Administration, or related field
• Professional certification such as:
• Certified Provider Credentialing Specialist (CPCS)
• Certified Professional Medical Services Management (CPMSM)
• (through the National Association Medical Staff Services)
• Experience working with managed care organizations and credentialing systems/databases

Core Skills

• Regulatory compliance & audit preparation
• Data management & accuracy
• Billing issue resolution
• Communication & coordination
• Time management and attention to detail

Pride Health offers eligible employee’s comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, auto, home insurance, pet insurance, and employee discounts with preferred vendors.