Credentialing & Enrollment Specialist

Qualifications

Education: High School Diploma or equivalency; Bachelor’s degree preferred

Certifications & Licenses: None

Essential Duties and Responsibilities

• Coordinate with Human Resources and department leaders to initiate credentialing for new providers upon hire.
• Collect and verify all necessary documents from providers (e.g., licensure, DEA, board certifications, malpractice coverage).
• Facilitate privileging and credentialing processes in accordance with KCHC policy.
• Maintain accurate, secure files and documentation for each provider.
• Monitor licensure, certifications, and other credential expirations; notify providers in advance of renewal deadlines and update files with new credentials.
• Initiate and manage the re-credentialing process at required intervals for all active providers.
• Perform periodic audits of Credentialing files and records to ensure that all required documents are collected and filed appropriately.
• Absorb and update provider profiles in credentialing databases and payer systems.
• Process and manage all initial enrollment applications and verifications in compliance with payers while ensuring completeness and accuracy.
• Submit provider enrollment applications to health plans and follow up until approval is secured.
• Track application status and proactively communicate progress and issues to leadership.
• Ensure timely enrollment with Medicaid, Medicare, and commercial payers to avoid delays in billing and reimbursement.
• Track application status and proactively communicate progress and issues to leadership.
• Initiate and manage re-enrollment process at required intervals for all active providers and payers to prevent lapses.
• Complete the enrollment application for new site locations and renewal of current locations.

Work Environment & Schedule

Must be able and comfortable working in a variety of settings including, but not limited to clinical environments and office spaces. Must be able to work nights and weekends as departmental needs arise.

Physical Demands

• Prolonged periods of sitting while working at a computer and viewing screens.
• Frequent use of hands and fingers for typing, writing, and operating office equipment.
• Requires close visual acuity to read screens, prepare and review documents, and assess information.
• Occasional standing and walking.
• Ability to move throughout office and clinical spaces as needed to perform job duties.
• Occasional lifting, carrying, or moving materials, equipment, or supplies weighing up to 25–50 pounds.

Core Competencies

• Communication: Demonstrates strong verbal, written, and digital communication skills; able to clearly explain complex information.
• Judgment & Decision-Making: Provides thoughtful input into operational and program decisions.
• Accountability & Self-Management: Works independently and efficiently, managing multiple responsibilities with minimal supervision.
• Teamwork & Collaboration: Builds effective working relationships across teams, departments, and the community.
• Problem-Solving & Initiative: Applies critical thinking and initiative to resolve issues and improve service delivery.

Compliance Responsibilities

As part of Kinston Community Health Center’s commitment to ethical practices and regulatory compliance, all employees are expected to:

• Act in accordance with the KCHC Employee Handbook, policies and procedures, and all applicable federal and state laws.
• Promptly report any known or suspected violations of compliance/safety standards.