Credentialing Specialist (47605)

CHARLOTTE EYE EAR NOSE AND THROAT ASSOCIATES PA • Charlotte, NC

55d • Hybrid

About The Position

CEENTA is seeking a highly detail-oriented Credentialing Specialist to support provider enrollment and credentialing processes. This role is vital to ensuring providers are properly credentialed and compliant with all regulatory and payer requirements, helping maintain seamless patient care and operational efficiency.

Requirements

• High school diploma or GED, required
• Experience with credentialing systems
• Strong MS Office skills
• Detail-oriented and organized
• Strong communication skills

Nice To Haves

• Minimum of 2 years’ credentialing experience, highly preferred
• NAMSS CPSC certification (preferred but not required)

Responsibilities

• Maintain individual provider files to include up-to-date information needed to complete the required governmental and commercial payer credentialing applications
• Maintain accurate provider profiles on CAQH, NPPES and CMS databases
• Complete credentialing applications to add providers to commercial payers, CMS and Medicaid
• Complete re-credentialing requests issued by government and commercial payers
• Verify and maintain provider hospital privileges within CredentialStream
• Ensures all individual provider locations within the practitioner database match the CEENTA location reports
• Work closely with the Business Office to identify and resolve any denials or authorization issues related to credentialing
• Maintain the provider flu and PPD grids and forward to appropriate staff
• Update and/or provide verification of all payer directories via electronic submission, email (spreadsheets) and/or phone
• Provides profile updates/verifications for active and termed CEENTA providers to various facilities
• Maintain internal tracking tools
• Submit reports and respond to inquiries

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED