Credentialing Specialist at Raleigh Radiology LLC

Raleigh, North Carolina, United States -

Full Time

Start Date

Immediate

Expiry Date

10 May, 26

Salary

0.0

Posted On

09 Feb, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Credentialing, Payor Enrollment, Compliance, Organizational Skills, Attention to Detail, Communication, Problem Solving, Microsoft Office Suite, Electronic Record-Keeping, Discretion, Healthcare Experience, Provider Relationships, Documentation, Licensure Monitoring, Billing Support, Team Collaboration

Industry

Hospitals and Health Care

Description

Description Raleigh Radiology is seeking a detail-driven, highly organized Credentialing Specialist to join our growing team. This role is ideal for someone who thrives in a fast-paced healthcare environment, enjoys managing complex credentialing processes, and takes pride in ensuring providers and payor relationships remain compliant and up to date. While the position is based out of our Business Support Office, remote work may be considered for the right candidate. Requirements As our Credentialing Specialist, you will serve as the primary point of contact for provider and payor credentialing, ensuring compliance with federal and state regulations while supporting our physicians, leadership, and billing partners. Key responsibilities include: Manage initial credentialing and re-credentialing for providers across Raleigh Radiology and its affiliated entities Complete, submit, renew, and track payor credentialing, enrollments, and re-enrollments Review applications and supporting documentation for accuracy, eligibility, and completeness Identify discrepancies and proactively follow up with providers and payors Process new provider privileges related to payor contracts Maintain and monitor provider licensure, certifications, and expiration dates Ensure timely updates to provider credentials and documentation Act as a liaison between administration, medical staff, health plans, and external billing partners Respond to provider, payor, and billing inquiries and resolve discrepancies Maintain accurate provider data within credentialing systems (including VerityStream) and the practice website Support accounting and billing teams as needed Handle sensitive and confidential information with the highest level of discretion Ensure ongoing compliance with all applicable federal and state regulations What We’re Looking For Education & Experience Associate degree from an accredited institution 1–3 years of credentialing experience required Healthcare experience preferred; physician practice experience strongly preferred Certification (Preferred but not required) CPCS (Certified Provider Credentialing Specialist) CPMSM (Certified Professional Medical Services Management) Skills That Will Help You Succeed Strong knowledge of credentialing and payor enrollment processes Excellent organizational skills with exceptional attention to detail Clear, professional written and verbal communication Ability to manage multiple priorities and meet tight deadlines Comfortable working independently with minimal supervision Proficient with Microsoft Office Suite and electronic record-keeping systems Professional, dependable, flexible, and solution-oriented

Responsibilities

The Credentialing Specialist will manage initial credentialing and re-credentialing for providers, ensuring compliance with regulations. They will also act as a liaison between various stakeholders and maintain accurate provider data within credentialing systems.