Medical Credentialing Specialist

Description

Position Overview

Carolina Nephrology is seeking an experienced Medical Credentialing Specialist. The ideal candidate will have extensive experience managing provider credentialing in a multi-provider healthcare environment and possess strong proficiency with Qgenda or similar credentialing software. This individual will play a key role in ensuring providers maintain compliance with all credentialing, privileging, and payer enrollment requirements across multiple healthcare settings.

Key Responsibilities

• Manage the initial credentialing and re-credentialing processes for 20–40 providers across ambulatory surgery centers, hospitals, dialysis centers, and outpatient clinics.
• Oversee payer enrollment and re-enrollment activities, including Medicare, Medicaid, and commercial insurance plans.
• Maintain and update provider information within CAQH and other credentialing databases.
• Coordinate credentialing and privileging activities with 7–12 hospitals, multiple dialysis organizations, and 20–25 clinic locations.
• Manage facility credentialing and ensure organizational compliance with regulatory and accreditation requirements.
• Monitor credentialing expiration dates and proactively managing renewals to prevent lapses in provider participation.
• Collaborate with physicians, administrators, practice leadership, and external organizations to facilitate timely credentialing approvals.
• Maintain accurate credentialing records and ensure compliance with federal, state, payer, and organizational standards.

Requirements

Qualifications

• Demonstrated experience in healthcare credentialing, payer enrollment, facility credentialing, and CAQH management.
• Strong working knowledge of QGenda or similar credentialing software is required.
• Experience credentialing providers across multiple healthcare environments, including hospitals, ASCs, dialysis facilities, and physician practices.
• Thorough understanding of credentialing regulations, accreditation standards, and payer requirements.
• Exceptional organizational, time-management, and communication skills.
• Strong attention to detail and ability to manage multiple projects and deadlines simultaneously.
• Ability to work independently while maintaining a high level of accuracy and accountability.

What We Offer

• Competitive compensation based on experience and qualifications.
• Opportunity to support a growing, provider-focused nephrology organization.
• Collaborative and professional working environment.

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Hours: Monday-Friday 9am-5pm

Pay: $25.00 - $27.00 per hour