Job Description

Orthopaedic Specialists of North Carolina is seeking a full-time Credentialing Specialist to facilitate the credentialing process for all providers, new hires, and all contractual obligations with payers.

This position is a hybrid position (mix of in-office and remote) with hours Monday-Friday 8A-5P.

The ideal candidate is:

• Detail-oriented
• Priority-driven
• Highly organized
• Able to multitask efficiently while producing measurable results
• Proficient with juggling competing priorities successfully, understanding a sense of urgency
• An open and honest communicator with the ability to ask questions and request help

A candidate should possess the ability to work with efficiency and quality in a multi-specialty orthopaedic practice. Job duties include but are not limited to:

• Ensure all providers are appropriately credentialed with all payors, hospitals, surgery centers, etc.
• Compile and maintain current and accurate data for all providers, including CAQH files, in credentialing databases and spreadsheets
• Organize and maintain physical and online ASC and provider files
• Maintain current copies of current state licenses, DEA certificates, and any other required credentialing documents for all providers
• Assist with researching, developing, writing, and updating credentialing policies, procedures, methods, and guidelines
• Communicate with representatives of insurance companies, hospitals, surgery centers, MCOs, CINs, etc. for follow-up of applications and any other issues requiring additional investigation and evaluation
• Audit health plan directories for current and accurate provider information and provides health plans with up-to-date information pertaining to providers to avoid billing denials
• Process initial credentialing and re-credentialing applications for OrthoNC Ambulatory Surgical Center and practice clinic locations as needed.
• Enroll ASC and providers to insurance payors as needed
• Maintain confidentiality of all provider information
• Perform miscellaneous job-related duties as needed
• Monitor staff credentials and licenses
• Assume other credentialing-related duties and various special projects as assigned

Qualifications:

• Associate's or Bachelor's Degree or equivalent experience in Business, health care, or related area
• Strong interpersonal and communication skills

Orthopaedic Specialists of North Carolina offers a team-oriented work environment and competitive compensation package, with full-time benefits including: health, dental, vision, life insurance, short-term and long-term disability, paid holidays, paid time off, paid training, and 401(k). Additional supplemental benefits are offered. For more information about our company, please visit our website at We are an equal opportunity employer.

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