Clinical Credentialing And Compliance Specialist

High Point University

High Point, North Carolina, United States
Dental and optometry regulatory requirements
Medical billing and payer requirements
Credentialing software and compliance tools
This role ensures that all providers meet federal, state, accreditation, payer, and organizational requirements prior to appointment and throughout the duration of their service

Job Summary

  • This role ensures that all providers meet federal, state, accreditation, payer, and organizational requirements prior to appointment and throughout the duration of their service.
  • The Specialist serves as a key liaison between providers, licensing boards, payers, and internal departments to maintain accurate, timely, and compliant credentialing records.
  • Assist with audits, site visits, and surveys by accrediting bodies and regulatory agencies; compile and present requested documentation.

Matching Summary

This role ensures that all providers meet federal, state, accreditation, payer, and organizational requirements prior to appointment and throughout the duration of their service.

Skills & Requirements

Must-have

  • Dental and optometry regulatory requirements
  • Medical billing and payer requirements
  • Credentialing software and compliance tools
  • Medicare enrollment and revalidation knowledge

Nice-to-have

  • Strong analytical and problem-solving skills
  • Excellent communication and interpersonal skills
  • Detail-oriented and highly organized

Key Requirements

  • Associate’s degree required
  • Minimum of 2 years of healthcare credentialing experience
  • Certified Provider Credentialing Specialist (CPCS) or Certified Professional Medical Services Management (CPMSM) preferred
  • Experience in an academic dental or optometry clinic setting preferred

Work Rights

Not specified

Tailored Resume

Cover Letter