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

Generations Family Practice jobs

Credentialing Specialist