Senior Credentialing Specialist- Belmont, NC

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

Position Summary
Compleat KiDZ is seeking an experienced and detail-oriented Senior Credentialing Specialist to oversee and manage the credentialing and payer enrollment process for clinical providers across our pediatric therapy clinics. This role is responsible for ensuring providers are properly credentialed, enrolled, licensed, and maintained with insurance payers and regulatory organizations to support uninterrupted patient care and clinic operations.

Position Summary
Compleat KiDZ is seeking an experienced and detail-oriented Senior Credentialing Specialist to oversee and manage the credentialing and payer enrollment process for clinical providers across our pediatric therapy clinics. This role is responsible for ensuring providers are properly credentialed, enrolled, licensed, and maintained with insurance payers and regulatory organizations to support uninterrupted patient care and clinic operations.
The Senior Credentialing Specialist will serve as a subject matter expert on provider credentialing and payer enrollment, manage complex credentialing activities, monitor deadlines, resolve enrollment issues, and work closely with internal clinical, operations, billing, and recruiting teams.
Duties

• Maintains provider information in online credentialing databases and system, completes provider credentialing and re-credentialing applications; monitors applications and follows-up as needed.
• Compiles and maintains current and accurate data for all providers.
• Maintains confidentiality of provider information.
• Maintains copies of current state licenses, malpractice coverage and any other required credentialing documents for all providers.
• Maintains knowledge of current health plans and agency requirements for credentialing providers.
• Tracks license and certification expirations for all providers to ensure timely renewals.
• Maintains and updates all providers' CAQH and re-attest when necessary.
• Ensures practice addresses are current with health plans, agencies and other entities.
• Tracks license, DEA and professional liability expirations for appointed providers.
• Maintains Provider appointment files, and information in credentialing database.
• Ensures proper coordination with providers, payers, and office personnel.
• Audits health plan directories for current and accurate provider information.
• Performs other duties as assigned.
  

Education And Experience

• Knowledge of provider enrollment processes and requirements for Commercial, State and Government insurance payers. CMS Federal and State guidelines related to enrollment policies.
• Ability to interact with diplomacy with individuals from a variety of backgrounds and organizational levels.
• Associate degree or above is preferred.