Credentialing Specialist

Cedar Park TMS; Plano (TX); On-site; USD 50,000 - 70,000; Full time

Job summary

Beacon Behavioral Partners in Plano, TX is seeking a Credentialing Specialist to join our Revenue Cycle Team onsite at our corporate office. This full-time role focuses on credentialing, provider enrollment, and data maintenance across multiple states to support high-quality patient care.

Responsibilities include data compilation, primary source verification, and managing credentialing applications while ensuring compliance and accuracy.

Qualifications

• Bachelor's degree in healthcare administration, business administration, or a related field preferred.
• Minimum of 3 years of provider enrollment and credentialing experience.
• Extensive knowledge of provider enrollment regulations and guidelines (Medicare, Medicaid, commercial payer).
• Strong understanding of credentialing processes and best practices.
• Experience with payer enrollment portals and systems.
• Excellent communication, interpersonal, and organizational skills.

Responsibilities

• Compile and maintain current and accurate data for all providers.
• Data entry and maintenance of provider information in credentialing databases and systems (Credential My Doc, CAQH, PECOS, NPPES, SharePoint).
• Perform primary source verification of State licenses, DEA, and board certification.
• Complete provider initial and re-credentialing applications.
• Audit applications for accuracy and completeness.
• Submit completed credentialing applications and documentation to payers.
• Monitor application progress and follow up with payers until in-network status is confirmed.
• Maintain copies of licenses, DEA certificates, malpractice coverage, and other credentialing documents.
• Track expirations to ensure timely renewals.

Skills

Communication skills

Interpersonal skills

Organizational skills

MS Office

Attention to detail

Education

Bachelor's degree in healthcare administration or related field

Tools

Microsoft Office Suite (Word, Excel, PowerPoint)

Credentialing databases (CAQH, PECOS, NPPES)

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Credentialing Specialist

REG FULL TIME Clerical US

3 days ago Requisition ID: 3207

Beacon Behavioral Partnersis looking for a Credentialing Specialist to join our team. This full-time position has the opportunity to work with our Revenue Cycle Team and will work onsite at our corporate office located in Plano, TX. We are a growing network of physician-driven psychiatric practices withover 25 years of management experiencewithin the behavioral health industry. Committed to reducing the barriers and burdens that come with owning private practice, Beacon fullymanages administrative responsibilitieswhile allowing practices tomaintain clinical autonomy. This approach allows physicians to focus on what they do best –taking care of patients.

Beacon Behavioral Partnersnow guides practices across Louisiana, Arkansas, Mississippi, Florida, Texas and multiple other states across the US. Beacon Behavioral Partners leverage access to an expansive network ofover 1000 staff members, including psychiatrists, psychologists, nurse practitioners, mental health therapists and recreational therapists at the forefront of the industry. Its experienced and forward-thinking physician advisory board provides clinicians with a supportive community for building best practices and sharing insights for an enhanced patient experience.

RESPONSIBILITIES AND DUTIES

• Responsible for Compiling and maintaining current and accurate data for all providers
• Responsible for Data entry and maintaining provider information in online credentialing databases and system (Credential My Doc, CAQH, PECOS, NPPES, and SharePoint)
• Responsible for primary source verification of State license, DEA, and Board certification
• Responsible for completing provider initial and re-credentialing applications
• Audits applications for accuracy and completeness
• Responsible for revalidation requests issued by all payers
• Responsible for submitting completed credentialing application and supporting documentation to all requested payers
• Responsible for monitoring application progress and following up with payers as needed until confirmation of “in network” status has been received
• Responsible for maintaining copies of current state licenses, DEA certificates, malpractice coverage and any other required credentialing documents for all providers. As well as tracking all state license, DEA, and board certification expirations for all providers to ensure timely renewals
• Responsible for tracking CME and, sending quarterly updates to providers
• Utilizes strong research skills to gather pertinent information regarding providers
• And all other duties as assigned
• Maintain billing insurance grid, provider insurance grid, and each physician’s spreadsheet up to date on current insurance changes.
• Maintain practitioner electronic file by keeping all applications/licensures current.
• Collects and validates documents to ensure accuracy of all credentialing elements.
• Assists in training and monitoring of credentialing specialists, assign work and review for accuracy.
• Assist in streamlining credentialing process, onboarding and offboarding for providers and new centers.
• Escalate any personnel issues to Credentialing Supervisor
• Report and/or escape provide enrollment issues to RCM leadership.

Qualifications:

Bachelor's degree in healthcare administration, business administration, or a related field preferred.

Minimum of 3 years of experience in provider enrollment and credentialing.

Extensive knowledge of provider enrollment regulations and guidelines, including Medicare, Medicaid, and commercial payer requirements.

Strong understanding of credentialing processes and best practices.

Experience with various payer enrollment portals and systems.

Excellent communication, interpersonal, and organizational skills.

Ability to manage multiple projects simultaneously and meet deadlines.

Detail-oriented and highly accurate.

Strong analytical and problem-solving skills.

Proficiency in Microsoft Office Suite (Word, Excel, PowerPoint)

Certified Provider Credentialing Specialist (CPCS) certification preferred.

Only those selected for interviews will be contacted. Pre-employment screenings and verification of credentials (if applicable) is required prior to start date. Beacon uses E-verify to confirm the employment eligibility of all newly hired employees. To learn more about E-verify, including your rights and responsibilities, please visit www.dhs.gov/E-verify (http://www.dhs.gov/E-verify).

Beacon is an Equal Opportunity Employer.