Credentialing Specialist

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
.

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 Verity Stream) 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

• Associate degree from an accredited institution preferred not required
• 1–3 years of credentialing experience required
• Healthcare experience preferred;
  physician practice experience strongly preferred

• CPCS (Certified Provider Credentialing Specialist)
• CPMSM (Certified Professional Medical Services Management)

• 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