Provider Enrollment and Credentialing Specialist – Flexible Part-Time

Jobtailor; Cary (NC); Hybrid; USD 60,000 - 90,000; Full time

Job summary

Jobtailor is seeking a credentialing specialist in North Carolina to manage the provider enrollment and credentialing lifecycle for behavioral health and medical providers. You will drive initial applications, follow-ups, enrollment, and recredentialing across multiple payers.

You will verify credentials, submit Medicare and commercial payer applications, stay current with CMS rules and credentialing standards, and collaborate with internal teams to resolve issues efficiently.

Qualifications

• Must have hands-on provider enrollment and credentialing experience for behavioral health and medical providers.
• Strong knowledge of Medicare enrollment (Parts A, B, C) and commercial payer processes.
• Familiarity with credentialing standards, regulations, and compliance requirements.

Responsibilities

• Manage the complete provider enrollment and credentialing process from initial applications to recredentialing.
• Verify education, training, work history, licensure, and certifications for providers.
• Submit enrollment applications to Medicare and commercial payers.
• Maintain knowledge of CMS regulations and payer requirements.
• Collaborate with internal teams to resolve enrollment issues and track progress.
• Negotiate contracts and reimbursement rates with payers as needed.
• Maintain provider records and assist with training of team members.

Skills

Provider Credentialing

Medicare Enrollment

Credentialing Regulations

Application Submission

Recredentialing

Provider Records

Negotiation Skills

Attention to Detail

Organizational Skills

Written Communication

Tools

MedTrainer

Credentialing Database

Job description

• Manage the complete provider enrollment and credentialing process, including initial applications, follow-up, enrollment, and recredentialing
• Verify provider education, training, work history, licensure, certifications, and other required credentials
• Complete and submit provider enrollment applications to Medicare and commercial insurance payers
• Maintain knowledge of Medicare Parts A, B, and C
• Enroll and credential providers with in-state and out-of-state payers
• Communicate with insurance companies to track applications, resolve issues, and obtain updates
• Negotiate insurance contracts and reimbursement rates
• Maintain and assist with delegated credentialing agreements
• Guide healthcare providers through paperwork and answer enrollment-process questions
• Stay informed about regulations and standards from CMS, OIG, TJC, and other applicable organizations
• Maintain provider records, reports, and application updates in MedTrainer
• Collaborate with internal departments to resolve credentialing and enrollment concerns
• Assist with training and supporting other team members as needed

Requirements

• Must currently reside in North Carolina
• Previous hands-on experience with provider enrollment and credentialing for both behavioral health and medical providers
• Strong working knowledge of Medicare enrollment, including Medicare Parts A, B, and C
• Experience completing applications for commercial insurance companies and multistate payer networks
• Exceptional attention to detail and organizational skills
• Strong written and verbal communication skills
• Ability to manage multiple applications, priorities, and deadlines
• Familiarity with applicable credentialing standards, regulations, and compliance requirements
• Experience using MedTrainer or a comparable credentialing database
• Ability to work independently while collaborating effectively with providers and team members
• Experience with insurance contract and reimbursement-rate negotiations
• Must be available more than just nights and weekends
• Applications must live in the state of North Carolina

Core Competencies

Demonstrates expertise in managing the provider enrollment and credentialing process, including knowledge of Medicare Parts A, B, and C, and experience with commercial insurance applications. Strong organizational and communication skills are essential for guiding healthcare providers and collaborating with internal teams.

Highest-signal resume keywords

• Provider Enrollment Management
• Medicare Enrollment Knowledge
• Credentialing Standards Familiarity
• Insurance Contract Negotiation
• MedTrainer Experience

ATS Optimization Keywords

Hard Skills

• Provider Credentialing
• Medicare Parts A, B, and C
• Commercial Insurance Applications
• Credentialing Regulations
• Application Submission
• Recredentialing Process
• Provider Record Maintenance
• Negotiation Skills
• Attention to Detail
• Organizational Skills

Soft Skills

• Written Communication
• Verbal Communication
• Collaboration
• Independence
• Problem-Solving

Industry Keywords

• Provider Enrollment
• Credentialing Process
• Behavioral Health
• Medical Providers
• Insurance Payers
• CMS Regulations
• OIG Standards
• TJC Compliance

Tools & Technologies

• MedTrainer
• Credentialing Database