Credentialing & Provider Enrollment Specialist

TEXAS HEARING INSTITUTE; Houston (TX); On-site; USD 32,000 - 34,000; Full time

Job summary

Texas Hearing Institute, based in Houston, TX, is seeking a Credentialing & Provider Enrollment Specialist to manage credentialing, enrollment, recredentialing, payer contracting support, and regulatory compliance. The role interfaces with THI providers and payers to ensure in-network status and proper reimbursement.

The position also covers front desk duties as needed to support the department's operations.

Qualifications

• High school diploma or equivalent required; associate or bachelor degree preferred.
• Minimum 2 years of provider credentialing and enrollment experience.
• Working knowledge of TMHP/PEMS, Medicare PECOS, CHIP, and commercial payer enrollment requirements.
• Experience maintaining CAQH provider profiles.
• Understanding of Joint Commission, NCQA, URAC accreditation standards.

Responsibilities

• Oversee 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 licenses, registrations, and certifications.
• Prepare weekly credentialing reports.
• Ensure compliance with payer enrollment requirements.
• Assist with provider contracting activities.
• Coordinate payer participation requests.
• Maintain contract documentation and monitor enrollment status.

Skills

Organizational skills

Follow-up skills

HIPAA compliance

Education

High school diploma or equivalent

Associate or Bachelor's degree preferred

Tools

CAQH

PECOS

TMHP/PEMS

Job description

Job Title: 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

About Us

Texas Hearing Institute is a Houston-based nonprofit dedicated to serving individuals with hearing loss. Our programs include audiology, speech therapy, family services, and the Melinda Webb School. The Business Office team supports all of these programs by keeping operations running smoothly and the organization's billing and credentialing accurate.

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