Credentialing Specialist

Cole Health; Spring (TX); Hybrid; USD 28,000 - 30,000; Full time

Benefits offered by this job

Hybrid/Remote work options

Overtime during audit periods

Job summary

Cole Health in Spring, TX, seeks a Credentialing Specialist to manage credentialing and re-credentialing for therapists including SLPs, OTs, and PTs. You will verify licenses, certifications, education, and work history to support patient safety, payer enrollment, and regulatory compliance.

Hybrid work options available (remote or in-clinic) with a clinic in Spring, TX. Strong organizational skills and knowledge of NCQA/URAC/Joint Commission standards are essential.

Qualifications

• High school diploma or equivalent; associate or bachelor’s degree preferred.
• 2+ years of credentialing/healthcare admin experience.
• Familiarity with credentialing software and databases.
• Strong understanding of NCQA, URAC, Joint Commission and therapy licensure bodies.
• Excellent organizational and communication skills.
• Ability to manage multiple priorities and deadlines.
• Proficiency in Microsoft Office (Excel, Word, Outlook).

Responsibilities

• Process initial credentialing and re-credentialing applications for therapists.
• Perform primary source verification of licenses, certifications, education, and work history.
• Maintain provider files in credentialing software/databases (CAQH, Symplr, MD-Staff).
• Track and manage expiration dates for licenses, certifications, CEUs, and liability insurance.
• Coordinate enrollment and privileging with operations, payers, and partners.
• Ensure compliance with NCQA, URAC, Joint Commission, CMS and state boards.
• Prepare credentialing files and reports for audits.
• Communicate with therapists to obtain missing documentation.
• Respond to inquiries regarding credentialing status.
• Maintain confidentiality of provider information per HIPAA.
• Assist with audits related to credentialing compliance.
• Monitor licensure requirements across jurisdictions for multi-state practice or telehealth.

Skills

Credentialing experience

Healthcare administration

Microsoft Office

Communication skills

Education

High school diploma

Associate degree

Bachelor’s degree

Tools

CAQH

Symplr

MD-Staff

Job description

Schedule: Monday through Friday either 8am-5pm or 9am-6pm

Pay Rate:$20-$22/hr (depending on experience)

Location: Hybrid Remote/In-Clinic or Fully Remote

Clinic Location: 16835 Deer Creek Drive, Spring, TX 77379

Job Description: Clinical Specialist

The Credentialing Specialist is responsible for managing the credentialing and re-credentialing process for licensed therapists — including Speech-Language Pathologists (SLPs), Occupational Therapists (OTs), and Physical Therapists (PTs) — ensuring compliance with regulatory, accreditation, and organizational standards. This role verifies provider qualifications, licenses, certifications, and work history to support patient safety, risk management, and payer enrollment requirements.

Key Responsibilities

• Process initial credentialing and re-credentialing applications for speech, occupational, and physical therapists
• Perform primary source verification of state licenses, national certifications (e.g., ASHA CCC-SLP, NBCOT, NPTE), education, clinical training, malpractice history, and work references
• Maintain accurate and up-to-date provider files in credentialing software/databases (e.g., CAQH, Symplr, MD-Staff)
• Track and manage expiration dates for licenses, certifications, CEUs, and liability insurance coverage; proactively initiate renewal processes
• Coordinate with clinical operations, insurance payers, and facility/agency partners to complete enrollment and privileging
• Ensure compliance with NCQA, URAC, Joint Commission, CMS, state licensing boards, and payer-specific requirements
• Prepare credentialing files and reports for internal review and audits
• Communicate with therapists to obtain missing documentation or clarify discrepancies
• Respond to inquiries from internal departments, payers, and external agencies regarding credentialing status
• Maintain confidentiality of sensitive provider information in accordance with HIPAA
• Assist with internal and external audits related to credentialing compliance
• Monitor state-specific licensure requirements across multiple jurisdictions if supporting multi-state practice or telehealth therapy services

Required Qualifications

• High school diploma or equivalent required; associate or bachelor’s degree preferred
• 2+ years of experience in credentialing, healthcare administration, or a therapy/rehab services setting
• Familiarity with credentialing software and databases
• Strong understanding of credentialing standards (NCQA, URAC, Joint Commission) and therapy-specific licensure/certification bodies (state PT/OT/SLP boards, ASHA, NBCOT, FSBPT)
• Excellent organizational skills and high attention to detail
• Strong written and verbal communication skills
• Ability to manage multiple priorities and meet deadlines
• Proficiency in Microsoft Office (Excel, Word, Outlook)

Preferred Qualifications

• Certified Provider Credentialing Specialist (CPCS) certification
• Experience with payer enrollment processes for rehab/therapy services
• Experience credentialing across multiple states (for multi-state or telehealth practices)
• Knowledge of HIPAA and healthcare compliance regulations
• Office-based, hybrid, or fully remote depending on organization
• May require occasional overtime during audit periods or high-volume credentialing cycles