Specials Recovery RN CL
Cone Health
Job Overview
- Job Category: Registered Nurses
- Industry: Hospitals and Health Care
- Application Deadline: 19 September 2026
Job Description
Under the direct supervision of the respective authority, the Payor Enrollment Specialist plays a crucial role in overseeing the enrollment, credentialing, and re-credentialing activities for billable providers affiliated with multiple health plans and locations. This position requires providing administrative support to the practitioner network within the organization to facilitate efficient and accessible patient care. Efforts also involve maintaining an organized system for various provider documents and data in alignment with relevant local and regional compliance regulations.
Essential Job Function:
- Health professionals such as physicians, CRNAs, physician assistants, nurse practitioners, and LCSWs are registered across the entire healthcare system to participate in government-funded programs like Medicare and Medicaid as well as in managed care plans.
- Keeps the credentialing database up-to-date by documenting effective participation dates, renewal deadlines, necessary qualifications, provider identifiers, and licensure details to ensure current and accurate provider and facility information.
- Keeps abreast of licensure and certification obligations to successfully submit provider credentialing and re-credentialing forms.
- Aids in evaluating and analyzing the federal and state legislation controlling Medicare Accountable Care Organizations and/or Medicare Advantage plans to guarantee that regulatory obligations are sufficiently documented and monitored to meet compliance standards.
- Monitors and files necessary credentialing documentation for all providers to ensure timely renewals.
- Maintains and tracks current state licenses, DEA certificates, malpractice insurance, and any other essential credentialing paperwork for all providers, ensuring they are renewed in a timely manner.
- Keeps up-to-date with the current requirements for credentialing providers set by health plans and agencies.
- Meets the requirements set forth for enrolling as a Medicare and Medicaid provider.
- Assures the correctness of data entry for CMS providers and suppliers within the CMS database.
- Familiarity with CMS protocols and specifications for rendering providers and service facilities is essential.
- Explore problems related to enrollment processes and clearly convey the status of authorized provider enrollments.
- Carries out subsequent reviews of credentialing, re-credentialing, revalidation, re-verification submissions, and updates to personal information.
- Pinpoints areas that demand deeper investigation and analysis.
- Verifies variations and ensures suitable subsequent actions.
- Supports the escalation of enrollment concerns in a manner that leads to prompt resolutions.
- Handles requests from different healthcare entities and engages with internal and external stakeholders regarding enrollment matters as they happen.
- Executes any other responsibilities as designated.
Education:
- Required: Associate degree
Experience:
- Required: 3 years as a Registered Nurse and 1 year in a clinical specialty as defined by ANCC or national nursing organizations. Cardiac Specialty Experience and 2 years of telemetry, ED, PCU, or ICU experience.
Licensure/Certification/Listing:
- Required: Registered Nurse license in North Carolina or a Compact state BLS (CPR)-American Red Cross or AHA Healthcare Provider ACLS required within 6 months of hire.
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Job Overview
- Job Category: Registered Nurses
- Industry: Hospitals and Health Care
- Application Deadline: 19 September 2026