Credentialing Specialist

CLS Health PLLC•Webster, TX

About The Position

The Insurance Credentialing Specialist manages credentialing and re-credentialing for healthcare providers with insurance companies, government programs, and other payer organizations. The role ensures providers are properly enrolled, compliant, and eligible for reimbursement. It involves coordinating applications and payer enrollments, maintaining provider records and supporting documentation, monitoring application progress and renewal dates, and serving as a liaison among providers, practice management, and insurance companies.

Requirements

Experience with CAQH enrollment and maintenance.
Understanding of healthcare regulations, accreditation standards, and provider credentialing requirements.
Strong attention to detail and a high degree of accuracy in documentation and record management.
Excellent written and verbal communication skills, with strong interpersonal abilities.
Proficiency in credentialing software, databases, and Microsoft Office applications.
Ability to manage multiple projects, prioritize tasks, and meet deadlines in a fast-paced environment.
Time management and multitasking skills.
Analytical and problem-solving skills.
Data entry accuracy.
Knowledge of healthcare terminology.
Ability to work independently and meet deadlines.

Nice To Haves

Knowledge of Medicare and Medicaid credentialing processes.
Familiarity with medical terminology.

Responsibilities

Coordinate and manage provider credentialing and re-credentialing with commercial insurers, Medicare, and Medicaid.
Prepare and submit credentialing applications and supporting documentation.
Maintain accurate provider records in credentialing databases and systems.
Track application status and follow up with insurance companies to ensure timely approvals.
Ensure compliance with regulatory and accreditation standards, including CMS and NCQA.
Update provider information, including licenses, certifications, malpractice insurance, and hospital privileges.
Manage payer enrollments, terminations, and updates.
Serve as a liaison between providers, practice management, and insurance companies.
Monitor expiration dates and ensure timely renewals.
Assist with audits and maintain credentialing files for review.