Strategic Provider Credentialing & Enrollment Specialist

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

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.