Provider Credentialing & Enrollment Specialist

NeighborHealth Center, Inc.; Raleigh (NC); On-site; USD 55,000 - 75,000; Full time

Job summary

NeighborHealth Center is seeking a Credentialing Specialist to manage credentialing and recredentialing for our providers and ensure enrollment with participating health plans. The role includes primary source verification, CAQH maintenance, and data integrity, with collaboration across HR and Billing to ensure timely handoffs and issue resolution.

Ideal candidates have an associate degree (or equivalent) and at least 3 years of credentialing experience in a managed care setting, plus

Qualifications

• Associate degree preferred or equivalent combination of education and/or experience.
• Minimum 3 years’ experience in provider credentialing in a managed care setting.
• Experience with medical and professional credentialing processes, policies, and delegated credentialing requirements.

Responsibilities

• Initiate and support provider applications and data import for credential verification.
• Gather, verify, and evaluate confidential provider credentials per guidelines and standards.
• Perform initial credentialing and recredentialing to ensure current credentials and timely handoff of files.
• Respond to provider, client health plan, and internal inquiries promptly.
• Monitor expiring licensure, board, and professional certifications within required timeframes.
• Maintain provider data files using CAQH and submit data for credentialing.
• Ensure accurate data entry to preserve credentialing data integrity.
• Collaborate with HR for smooth credentialing hand-offs.
• Use follow-up to resolve discrepancies identified during credentialing.
• Monitor compliance and alert HR of undisclosed negative findings.
• Review, process, and distribute incoming correspondence related to credentialing.
• Keep HR and Billing informed of credentialing issues.
• Other duties as assigned.

Skills

Computer literacy

Interpersonal relations

Advocacy for diversity

Clear communication

Deadline sensitivity

Confidential information handling

Education

Associate degree

Tools

CAQH

Job description

NeighborHealth Center is seeking a Credentialing Specialist to manage credentialing and recredentialing for our providers and ensure enrollment with participating health plans. The role includes primary source verification, CAQH maintenance, and data integrity, with collaboration across HR and Billing to ensure timely handoffs and issue resolution.

Ideal candidates have an associate degree (or equivalent) and at least 3 years of credentialing experience in a managed care setting, plus