Provider Credentialing & Enrollment Expert

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

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.