Physician Credentialing Specialist

Texas Regional Physicians; Houston (TX); Hybrid; USD 34,000 - 55,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

401(k) retirement plan

Paid time off

Life insurance

Disability coverage

NAMSS certification support

Job summary

Texas Regional Physicians is seeking a detail-oriented Credentialing Specialist to manage initial credentialing, re-credentialing, privileging, and payer enrollment for physicians and advanced practice providers across TRP entities.

This role ensures timely, accurate credentialing in line with NCQA, CMS, The Joint Commission, and Texas Medical Board requirements, serving as the liaison between TRP providers, hospital staff offices, and payers.

Qualifications

• Two years of provider credentialing experience in a medical setting.
• NAMSS CPCS/CPMSM preferred or willingness to obtain.

Responsibilities

• Process initial credentialing and re-credentialing for physicians and APPs.
• Perform primary source verification of education, licensure, and certifications.
• Coordinate hospital privileging applications and delineation of privileges.
• Maintain audit-ready provider files in NCQA, CMS, and Texas Medical Board standards.
• Submit payer enrollment applications (Medicare, Texas Medicaid, commercial plans).

Skills

Attention to detail

Communication

Discretion

Organization

Education

Healthcare Administration or related degree preferred

Tools

Microsoft Excel

Microsoft Word

Microsoft Outlook

Job description

Description

About Texas Regional Physicians

Texas Regional Physicians (TRP) is a physician-led, multi-specialty medical group serving communities throughout the greater Houston area. TRP operates a network of outpatient clinics, ambulatory surgical facilities, and outpatient imaging centers, providing comprehensive primary care, orthopedic care, podiatric care and radiology services. We are committed to delivering high-quality, patient-centered care while fostering a collegial, physician-driven practice culture that supports clinical autonomy, work-life balance, and long-term career growth.

Position Summary

Texas Regional Physicians is seeking a detail-oriented Physician Credentialing Specialist to manage initial credentialing, re-credentialing, privileging, and payer enrollment for physicians and advanced practice providers across TRP's affiliated entities. The successful candidate will ensure timely, accurate, and compliant credentialing in accordance with NCQA, CMS, The Joint Commission, Texas Medical Board, and payer-specific requirements, serving as the primary liaison between TRP providers, hospital medical staff offices, and health plans.

Key Responsibilities

• Process initial credentialing and re-credentialing applications for physicians and advanced practice providers across all TRP entities.
• Conduct primary source verification of education, training, licensure, board certification, DEA registration, malpractice history, and work history through NPDB, ABMS, FSMB, AMA, and other approved sources.
• Maintain complete, accurate, and audit-ready provider files in compliance with NCQA, CMS, The Joint Commission, and applicable state and federal regulations.
• Coordinate hospital privileging applications, reappointments, and delineation of privileges across TRP-affiliated hospitals and ambulatory surgical facilities.
• Track and proactively manage expirables including medical licenses, DEA registrations, board certifications, BLS/ACLS, and malpractice coverage to prevent lapses in credentialing or billing eligibility.
• Serve as primary liaison with hospital medical staff offices, health plans, and delegated credentialing entities.
• Complete and submit payer enrollment applications for Medicare, Texas Medicaid, and commercial plans, including CAQH profile maintenance and revalidations.
• Maintain and update the credentialing database and provider data management system (e.g., symplr, MD-Staff, Cactus, Modio).
• Prepare provider files, verification summaries, and reports for credentialing committee and medical staff review.
• Respond to credentialing and privileging verification requests from outside hospitals, payers, and agencies.
• Support internal and delegated credentialing audits, ensuring ongoing survey and compliance readiness.
• Communicate proactively with providers regarding outstanding documentation, application status, and upcoming renewal deadlines.
• Partner with recruitment, onboarding, billing, and revenue cycle teams to align credentialing timelines with provider start dates.
• Maintain strict confidentiality of provider information in accordance with HIPAA and TRP policy

Requirements

Qualifications

• High school diploma or equivalent required; Associate's or Bachelor's degree in Healthcare Administration, Business, or a related field preferred.
• Minimum of two (2) years of provider credentialing experience in a medical group, hospital, health system, or managed care setting.
• CPCS (Certified Provider Credentialing Specialist) or CPMSM (Certified Professional Medical Services Management) through NAMSS preferred, or willingness to obtain.
• Working knowledge of NCQA, CMS, The Joint Commission, and Texas Medical Board credentialing, privileging, and enrollment standards.
• Experience with credentialing software and provider data management systems.
• Familiarity with CAQH, PECOS, NPPES, NPDB, and Texas Medicaid enrollment portals.
• Exceptional attention to detail with proven ability to manage multiple applications and deadlines simultaneously.
• Proficiency in Microsoft Office (Excel, Word, Outlook).
• Excellent written and verbal communication skills for coordination with physicians, medical staff offices, and payers.
• Demonstrated discretion in handling sensitive and confidential provider information.

Compensation & Benefits

• Competitive hourly compensation commensurate with experience and certification.
• Comprehensive benefits package: medical, dental, and vision insurance.
• Retirement plan with employer contribution (401(k)).
• Paid time off and company-recognized holidays.
• Employer-paid life insurance and short-term/long-term disability coverage.
• Support for continuing education and NAMSS certification, including exam and renewal fees.
• Modern credentialing software and administrative infrastructure provided.

Work Environment

This position is based out of TRP's Houston-area administrative office and supports credentialing operations across our clinic, outpatient imaging, and ambulatory surgical sites in Houston, Sugar Land, Beaumont, and Mesquite. The role is primarily office-based with limited travel; hybrid work arrangements may be available depending on business needs. Houston offers a low cost of living relative to other major U.S. metro areas, a diverse and vibrant community, excellent schools, and a wide range of cultural, culinary, and outdoor recreational opportunities.

Texas Regional Physicians is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees and physicians.