Senior Credentialing Specialist- Belmont, NC

About the Role

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 ensures 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.

Responsibilities

• Maintains provider information in online credentialing databases and systems, 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-attests 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 the 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.

Requirements

• Knowledge of provider enrollment processes and requirements for Commercial, State, and Government insurance payers.
• Familiarity with CMS Federal and State guidelines related to enrollment policies.
• Ability to interact diplomatically with individuals from a variety of backgrounds and organizational levels.
• Minimum 2 years of payer enrollment processing required.
• Experience processing NC Medicaid (NC Tracks) enrollment and revalidation applications.
• Proficient in Microsoft Office products, particularly Word, Excel, OneNote, and Outlook.

Qualifications

• Associate degree or above is preferred.
• Credentialing software experience (preferred).
• Ability to monitor the onboarding and terminations of all providers in the group and update accordingly.

Benefits

• Medical, Dental, and Vision Insurance
• Pet Insurance
• 401(k) with company match
• Paid vacation and holidays
• Career growth opportunities
• Supportive, team-oriented work environment