Job Summary
This position will work closely with Quality Improvement Manager and the Revenue Cycle Team in the clinic to support the timely providers initiatives for the clinic and related clinic locations. The credentialing specialist is responsible for monitoring and maintaining active credentialing status for all medical providers. The credentialing specialist would complete initial and subsequent enrollments and renewals for payors; maintain accurate up to date information on the CAQH, PECOs, NPPES, and CMS databases. Track all license, DEA, & mal-practice renewals. The credential specialist needs to be well versed in the standards and regulations set by the state of NC. Additionally, the credentialing specialist may have other responsibilities related to physician qualifications upkeep that would be in charge of.
Cary Medical Management is clinic management group with 8 locations and 30+ practitioners and looking to expand. They offer a full suite of adult and pediatrics services to the community. Generations is at the forefront of helping the community develop a strong value-based care system.
Duties
- Coordinate and manage initial credentialing, re-credentialing, and enrollment processes for all providers across commercial and governmental payers (e.g., Medicare, Medicaid, ACOs).
- Coordinate between Medical Directors and organize provider related events and meetings
- Maintain accurate and up-to-date provider data in credentialing databases and CAQH profiles.
- Prepare and submit credentialing applications and supporting documentation to insurance companies and regulatory agencies.
- Track application status and follow up on outstanding items to ensure timely completion.
- Ensure compliance with NCQA, CMS, and payer-specific standards.
- Collaborate with clinical leadership and operations teams to ensure credentialing timelines align with onboarding and scheduling needs.
- Respond to audits and requests for information from payers and internal stakeholders.
- Maintain digital and physical credentialing files in accordance with HIPAA and organizational policies.
- Monitor expirables (licenses, DEA, malpractice insurance, etc.) and proactively manage renewals.
- Support ACO initiatives by ensuring provider participation and compliance with quality reporting requirements.
- Coordinate between Medical Directors and organize provider related events and meetings
Job Skills
- Detail oriented
- Medical provider credentialing knowledge
- Excellent computer skills
- Effective and clear communication
- Willingness to learn and be proactive
Qualifications
- Certified Medical Staff Credentialing Specialist (CPCS) preferred
- Minimum 2 years of experience in healthcare credentialing, preferably in outpatient or primary care settings.
- Familiarity with CAQH, PECOS, NPPES, and payer portals.
- Strong knowledge of commercial and governmental insurance credentialing requirements.
- Experience working with ACOs or value-based care models is highly desirable.
- Proficient in Microsoft Office Suite and credentialing software (e.g., QGenda, Modio, or similar).
- Excellent organizational, communication, and follow-up skills.
- Ability to manage multiple priorities and meet deadlines in a fast-paced environment.
Job Types: Full-time, Part-time
Pay: $45,000.00 - $55,000.00 per year
Benefits:
- 401(k)
- Dental insurance
- Disability insurance
- Flexible schedule
- Health insurance
- Paid time off
- Vision insurance
Experience:
- Credentialing : 2 years (Preferred)
License/Certification:
- Certified Medical Staff Credentialing Specialist (CPCS) (Required)
Ability to Commute:
- Cary, NC 27513 (Required)
Ability to Relocate:
- Cary, NC 27513: Relocate before starting work (Required)
Work Location: In person
