Credentialing & Provider Enrollment Specialist

Texas Hearing Institute•Houston, TX

2d•Onsite

About The Position

Texas Hearing Institute (THI) is seeking an experienced Credentialing & Provider Enrollment Specialist to manage all aspects of provider credentialing, enrollment, recredentialing, payer contracting support, and regulatory compliance. This role acts as the main point of contact between THI, providers, and payers to ensure providers are credentialed, enrolled, and eligible for reimbursement. The position may also provide front desk coverage as needed to support departmental operations.

Requirements

High school diploma or equivalent required.
Minimum 2 years of provider credentialing and enrollment experience in a managed care plan, Medical Staff Services, or credentialing verification office.
Working knowledge of Texas Medicaid (TMHP/PEMS), Medicare (PECOS), CHIP, and commercial payer enrollment requirements.
Experience maintaining CAQH provider profiles.
Basic understanding of credentialing Joint Commission, NCQA, and URAC accreditation standards.
Working knowledge of provider contracting and payer enrollment processes.
Understanding of healthcare regulatory and compliance standards.
Strong organizational and follow-up skills.

Nice To Haves

Associate or bachelor degree preferred.

Responsibilities

Complete initial credentialing and recredentialing for all providers.
Submit and monitor provider enrollment applications.
Maintain provider files and credentialing documentation.
Maintain CAQH, PECOS, TMHP/PEMS, and other payer portals.
Track expiration dates for medical licenses, DEA registrations, Board certifications, Professional liability insurance, CPR certifications (if applicable), and Recredentialing cycles.
Follow up with payers until providers are confirmed in-network.
Maintain provider enrollment status reports.
Ensure compliance with payer enrollment requirements.
Assist with provider contracting activities.
Coordinate payer participation requests.
Maintain contract documentation.
Monitor provider participation status.
Communicate enrollment or contracting issues to leadership.
Monitor credentialing and enrollment timelines.
Identify providers approaching expiration or termination.
Prepare weekly credentialing reports.
Maintain accurate documentation for audits.
Maintain confidentiality in accordance with HIPAA regulations.