Credentialing Specialist

Position TitleCredentialing Specialist (PRN/Part-Time, Remote)CompanySLP onCALL, PLLCPosition TypePart-Time / PRNRemote (Work from Home)W-2 EmployeeUp to 10 hours per week (maximum 20 hours per pay period)Flexible schedule with no regularly assigned workdays or hours.Work may be completed independently based on workload, credentialing deadlines, and operational needs.Although specific work hours are not established, the Credentialing Specialist must maintain reasonable availability during standard business hours (MondayFriday, generally 8:00 a.m.5:00 p.m. Central Time) to contact insurance payers, respond to credentialing inquiries, participate in occasional meetings, and perform necessary follow-up activities with payers and providers.Any hours worked beyond the approved maximum must receive prior written authorization.Position SummarySLP onCALL, PLLC is seeking a detail-oriented and highly organized Credentialing Specialist to support the onboarding and enrollment of new Speech-Language Pathologists (SLPs) into the practice's existing payer networks. This position is responsible for managing credentialing and enrollment processes with Texas Medicaid & Healthcare Partnership (TMHP), Texas Medicaid Managed Care Organizations (MCOs), and commercial insurance payers with which SLP onCALL is already contracted and in-network.The Credentialing Specialist will coordinate all aspects of provider credentialing, recredentialing, payer attestations, revalidations, and provider data maintenance while ensuring compliance with payer requirements, regulatory standards, and organizational policies. This role requires excellent follow-up skills, strong attention to detail, and strict adherence to HIPAA privacy regulations and confidentiality requirements.Essential Job ResponsibilitiesCredentialing & EnrollmentCoordinate and complete initial credentialing and payer enrollment applications for Speech-Language Pathologists joining SLP onCALL, PLLC.Facilitate provider enrollment with TMHP, Texas Medicaid MCOs, and existing contracted commercial insurance payers.Prepare, submit, and track credentialing applications and supporting documentation.Monitor application status and conduct routine follow-up with payers, typically every 710 days, until final determination is received. Maintain accurate records of all submissions, communications, approvals, denials, and effective dates.Assist with recredentialing, revalidation, and payer-attestation requirements as assigned. Maintain and update CAQH profiles and payer portals to ensure provider information remains current and accurate. Verify provider licensure, certifications, NPI information, and other credentialing documentation as required.Documentation & ReportingMaintain credentialing logs, spreadsheets, and tracking systems. Organize and securely maintain electronic provider files and credentialing documentation.Provide routine status updates and weekly progress reports regarding credentialing activities, pending applications, barriers, and anticipated completion timelines. Archive approval letters, participation agreements, and enrollment confirmations. Communication & Follow-UpMaintain availability during regular payer business hours to conduct credentialing-related telephone calls, application follow-up, issue resolution, and communication with TMHP, Medicaid MCOs, commercial payers, and provider representatives.Promptly request and obtain missing documentation needed to support credentialing and enrollment activities.Communicate professionally and effectively with providers, payer representatives, and organizational leadership.Escalate delays, barriers, or payer-specific issues to leadership when appropriate.Compliance & QualityEnsure compliance with all credentialing standards, payer requirements, and organizational procedures.Maintain strict confidentiality of provider, patient, employee, and company information.Adhere to all HIPAA regulations and privacy/security requirements.Exercise sound judgment when handling sensitive information and protected health information (PHI).Support audit readiness by maintaining complete, accurate, and organized credentialing records.CollaborationCollaborate with leadership regarding credentialing priorities, timelines, and workflow improvements.Support the successful onboarding of Speech-Language Pathologists into established payer networks.Work independently while maintaining accountability for assigned credentialing projects and deadlines.Minimum RequirementsEducation & ExperienceHigh school diploma or equivalent required.Associate degree or higher preferred.Minimum one (1) year of healthcare credentialing, provider enrollment, medical office administration, insurance verification, or related healthcare administrative experience preferred.Experience with TMHP, Medicaid managed care plans, CAQH, and commercial payer credentialing processes preferred.Knowledge, Skills & AbilitiesWorking knowledge of provider credentialing and enrollment processes.Familiarity with Texas Medicaid and managed care credentialing requirements preferred.Experience using CAQH and payer credentialing portals.Strong organizational skills and exceptional attention to detail.Excellent written and verbal communication skills.Ability to manage multiple credentialing projects simultaneously and meet deadlines.Proficiency with Microsoft Office applications, including Excel, Word, Outlook, and cloud-based file management systems.Ability to work independently with minimal supervision in a remote environment.Strong problem-solving, critical thinking, and follow-up skills.Confidentiality & HIPAA RequirementsThis position requires access to confidential provider, business, employee, and potentially protected health information. The Credentialing Specialist must:Comply with all federal and state privacy laws, including HIPAA.Maintain strict confidentiality of all organizational, provider, employee, and patient-related information.Follow all company policies related to data security, document retention, and information sharing.Protect sensitive information from unauthorized disclosure, access, or use.Complete all required privacy, security, and compliance training.Understand that maintaining confidentiality and safeguarding sensitive information are essential functions of the position.Physical & Work Environment RequirementsAbility to work remotely using a secure and reliable internet connection.Ability to sit, type, and work on a computer for extended periods.Must maintain a private, professional workspace suitable for handling confidential and protected information.Must have the ability to make and receive business-related phone calls during standard payer business hours as necessary to fulfill job responsibilities.DisclaimerThis job description is intended to describe the general nature and level of work being performed. It is not intended to be an exhaustive list of all duties, responsibilities, or qualifications associated with the position. Credentialing approval decisions and processing timelines are controlled by insurance payers. The Credentialing Specialist is responsible for timely and accurate submission, tracking, documentation, and follow-up of credentialing activities, but is not responsible for payer processing timelines or credentialing outcomes.
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