Credentialing & Enrollment Specialist

Kinston Community Health•Kinston, NC

2h•Hybrid

About The Position

The Credentialing & Enrollment Specialist coordinates and administers provider credentialing, privileging, enrollment, and re-enrollment processes to support timely patient access, regulatory compliance, and reimbursement operations. This position maintains provider records, monitors licensure and certification requirements, manages payer enrollment activities, and ensures organizational readiness for audits and reviews. Working collaboratively with providers, leadership, Human Resources, and external agencies, the Credentialing & Enrollment Specialist helps ensure Kinston Community Health Center's providers remain properly credentialed, enrolled, and authorized to deliver services in support of the organization's mission to improve the health of our communities.

Requirements

High School Diploma or equivalency
Minimum of 2 years of insurance enrollment experience in a healthcare setting, preferably in an FQHC or similar environment.
Familiarity with credentialing requirements for HRSA, CMS, and state licensing boards.
Strong attention to detail and organizational skills.
Ability to establish and effective working relationships
Ability to communicate effectively both verbally and in writing
Ability to maintain accurate, timely, and complete documentation
Ability to maintain confidentiality and comply with HIPAA requirements.
Proficiency in the use of clinical billing software and standard office technology
Knowledge of provider enrollment processes and payer credentialing requirements
Must successfully pass required background checks in accordance with organizational policy.
Must comply with all organizational credentialing and screening requirements.

Nice To Haves

Bachelor’s degree preferred

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.
Assist, as needed, with policy revisions and preparation for scheduled, periodic and ad hoc audits (i.e. OSV, FTCA, etc.)
Set up and maintain 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.
All other duties as assigned.