Raleigh Radiology - Credentialing Manager presso Raleigh Radiology

Join Our Team at Raleigh Radiology!

Raleigh Radiology is a trusted leader in imaging services, known for our excellence in patient care and strong collaborative culture. We are looking for a highly organized and detail-oriented Credentialing Manager to join our Business Support team.

This individual will play a critical role in ensuring compliance with all federal and state regulations related to licensure, certification, and payer credentialing for our physicians and facilities. 

What You’ll Do

As the Credentialing Manager, you’ll serve as the main point of contact for all payer, provider, and hospital credentialing activities. You’ll manage the full credentialing lifecycle—from applications and renewals to payer enrollments—ensuring that all provider information is accurate, complete, and compliant. This position is a *HYBRID* position located in Raleigh, NC.

Key Responsibilities:

Credentialing 

a) Process initial credentialing and re-credentialing applications for Raleigh Radiology and its entities in a timely manner.

b) Screen practitioners’ applications and supporting documentation to ascertain their eligibility. Verify and update credentials for all medical staff of Raleigh Radiology and its entities

c) Demonstrates initiative and ability to make managerial decisions aligned with Raleigh Radiology standards and policies, ethics, and compliance program specific to eligibility determinations as it pertains to qualifications review cases

d) Identify discrepancies in information and conduct follow-ups.

e) Partners with leaders across Raleigh Radiology to improve collegial work environment, build trust, and accelerate communication or service delivery.

f) Assist customers (internal and external) with credentialing inquiries

g) Develops and maintains relationships with outside vendors to deliver seamless customer experiences.

h) Presents department or team strategy, progress to goals, and updates on department initiatives during team meetings, or other meetings as required- which include business leaders across Raleigh Radiology - to promote results, build relationships, and inspire continued performance.

i) Develops and executes strategy, communication, and project plans related to yearly quantity sufficient initiatives (e.g. technology implementations, reorganizations, etc.).

j) Responsible for developing and maintaining Credentialing policy and procedures, considering updated information, specific initiatives, and manager input in order to evaluate and implement

k) Presents metrics to Director, including action items and implementation strategies based on data, and analyzed for cause and effect for impact

l) Implements changes to improve productivity and resource management.

m) Demonstrates proficiency with software programs utilized in the organization and supports ongoing software upgrade changes.

n) Facilitates problem solving on high-risk/critical escalations extending beyond the bounds of established policy and procedures.

o) Process new Provider privileges for Payor contracts for Raleigh Radiology and its entities. 

p) Responsible for ensuring Provider reenrollment documents with Payors are processed correctly and in a prompt and timely fashion.

q) Accurately maintains the data for all providers in the Practice and tracks expiration of certifications and licenses.

r) Ensure that the providers update their certification or licensing in a timely fashion.

s) Act as a liaison between the Administration and medical staff.

t) Responsible for maintaining/updating CAQH website and Verity Stream for Provider and Practice. Ensuring that all provider documentation is complete, accurate, and up to date.

u) Ensure that the Practice complies with federal and state regulations regarding licensure and certification for medical professionals.

v) Presents metrics to leaders, including action items and implementation strategies based on data, and analyzes for cause and effect for impact.

w) Facilitates problem solving on high-risk/critical escalations extending beyond the bounds of established policy and procedures.

x) Keep sensitive information confidential.

What We’re Looking For:

• Education: Associate degree required; Bachelor’s degree preferred.
• Experience:   Previous experience in the healthcare sector preferred. Experience with Physician Practice & hospital credentialing preferred. 3-5 years of credentialing experience required. Supervisory experience preferred. Experience with CAQH database and application process.
• Certifications:   Certified Professional Medical Services Management (CPMSM) or Certified Provider Credentialing Specialist (CPCS) preferred.
• Skills:
  • Excellent attention to detail and organizational skills
  • Strong written and verbal communication skills
  • Proficiency with Microsoft Office Suite
  • Ability to prioritize tasks and meet deadlines in a fast-paced environment
  • Professional, dependable, and able to work independently with minimal supervision

Why Raleigh Radiology? At Raleigh Radiology, we believe our people are our greatest asset. Joining our team means becoming part of a supportive, mission-driven organization that values collaboration, integrity, and excellence.

We offer: 

• Competitive salary and benefits  
• Hybrid work flexibility
• Professional growth opportunities 
• Positive, team-oriented culture 

Apply today and help us continue delivering exceptional care at Raleigh Radiology.