Credentialing and Enrollment Specialist

Senior PsychCare•Houston, TX

1d•Onsite

About The Position

The Credentialing and Enrollment Specialist is responsible for managing provider credentialing, re-credentialing, and payer enrollment processes using the Medallion credentialing platform. This role ensures that healthcare providers are properly credentialed and enrolled with insurance networks in a timely and compliant manner.

Requirements

High school diploma or equivalent
2+ years of experience in provider credentialing and enrollment
Knowledge of payer enrollment processes, CAQH, and healthcare regulations
Familiarity with Medicare, Medicaid, and commercial insurance requirements
Strong attention to detail and organizational skills
Excellent communication and follow-up skills
Ability to manage multiple tasks and meet deadlines

Nice To Haves

Associate’s or Bachelor’s degree
Hands-on experience with the Medallion credentialing platform
Certification such as CPCS (Certified Provider Credentialing Specialist) or CPMSM
Experience working in a healthcare organization, medical group, or managed care environment
Experience with credentialing audits and compliance standards (e.g., NCQA, Joint Commission)

Responsibilities

Manage end-to-end provider credentialing and re-credentialing processes using the Medallion platform
Coordinate and process provider enrollment applications with commercial and government payers (e.g., Medicare, Medicaid, and private insurers)
Maintain accurate and up-to-date provider records within Medallion and internal systems
Track application status, follow up with payers, and resolve delays or discrepancies
Ensure compliance with regulatory standards, payer requirements, and organizational policies
Verify provider credentials including licenses, certifications, malpractice insurance, and work history
Prepare and submit credentialing packets and enrollment applications
Communicate with providers to obtain required documentation and updates
Monitor expiration dates and initiate recredentialing cycles proactively
Generate reports and maintain audit-ready documentation
Collaborate with internal departments such as billing, compliance, and HR