Senior Credentialing & Payer Enrollment Specialist

Compleat Kidz; Belmont (NC); On-site; USD 65,000 - 90,000; Full time

Job summary

Compleat KiDZ is seeking a Senior Credentialing Specialist to oversee credentialing and payer enrollment for clinical providers across our pediatric therapy clinics. You will ensure providers are credentialed, enrolled, licensed, and maintained with insurance payers and regulatory bodies to support uninterrupted patient care and clinic operations.

The Senior Credentialing Specialist will manage complex credentialing activities, monitor deadlines, resolve enrollment issues, and collaborate with

Qualifications

• Knowledge of provider enrollment processes and requirements for Commercial, State and Government insurance payers, CMS guidelines.
• Diplomacy when interacting with diverse stakeholders at various levels.
• Associate degree or higher is preferred.

Responsibilities

• Maintains provider information in online credentialing databases and systems, and tracks credentialing applications.
• Monitors license, DEA, malpractice, and other credentialing documents for all providers.
• Ensures provider licenses and credentials are renewed timely.
• Maintains knowledge of health plans and credentialing requirements across entities.
• Audits provider directories for accuracy and completeness.
• Coordinates with providers, payers, and office staff to resolve enrollment issues.

Skills

Provider enrollment

Credentialing

Payer enrollment

Data management

Regulatory knowledge

Education

Associate degree or higher

Tools

CAQH

Job description

Compleat KiDZ is seeking a Senior Credentialing Specialist to oversee credentialing and payer enrollment for clinical providers across our pediatric therapy clinics. You will ensure providers are credentialed, enrolled, licensed, and maintained with insurance payers and regulatory bodies to support uninterrupted patient care and clinic operations.

The Senior Credentialing Specialist will manage complex credentialing activities, monitor deadlines, resolve enrollment issues, and collaborate with