Credentialing & Provider Enrollment Specialist

Credentialing & Provider Enrollment Specialist

Supervisor: Business Office Director

Texas Hearing Institute (THI) | Houston, TX (On-site)

Schedule: Monday Thursday: 7:30 am 5:30 pm Friday: 7:30 am 3:00 pm 40 hours/week

Compensation: $23-$25

Position Summary

We are looking for an experienced Credentialing & Provider Enrollment Specialist to oversee all aspects of provider credentialing, enrollment, recredentialing, payer contracting support, and regulatory compliance. This position serves as the primary liaison between THI, providers, and commercial and government payers to ensure providers remain credentialed, enrolled, and eligible for reimbursement. This role will provide front desk coverage only as needed to support departmental operations.

What You Will Do

• 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)
• 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.

What We're Looking For

• High school diploma or equivalent required; associate or bachelor degree preferred
• Minimum 2 years of provider credentialing and enrollment 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

Schedule and Compensation

• Monday Thursday: 7:30 am 5:30 pm/ Friday: 7:30 am 3:00 pm
• $23-$25/ hr