Senior Credentialing Specialist- Belmont, NC

Position Summary 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 is responsible for ensuring providers are properly credentialed, enrolled, licensed, and maintained with insurance payers and regulatory organizations to support uninterrupted patient care and clinic operations. Position Summary 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 is responsible for ensuring 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. Duties Maintains provider information in online credentialing databases and system, 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-attest 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 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. Education And Experience Knowledge of provider enrollment processes and requirements for Commercial, State and Government insurance payers. CMS Federal and State guidelines related to enrollment policies. Ability to interact with diplomacy with individuals from a variety of backgrounds and organizational levels. Associate degree or above is preferred. #J-18808-Ljbffr Compleat Kidz