Provider Credentialing & Enrollment Specialist

Senior PsychCare; Houston (TX); Presencial; USD 42 000 - 66 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Competitive salary

Comprehensive benefits

Resumo da oferta

Senior PsychCare in Houston, TX is seeking a Credentialing and Enrollment Specialist to manage provider credentialing, re-credentialing, and payer enrollment using the Medallion platform. This role ensures that healthcare providers are properly credentialed and enrolled with insurance networks in a timely and compliant manner.

The position involves end-to-end credentialing, coordinating with payers including Medicare/Medicaid, maintaining records, and generating audit-ready documentation in a

Qualificações

• High school diploma or equivalent; Associate's or Bachelor's degree preferred.
• 2+ years of provider credentialing and enrollment experience.
• Experience with Medallion credentialing platform preferred.
• Knowledge of payer enrollment, CAQH, and healthcare regulations.
• Familiarity with Medicare, Medicaid, and commercial insurance requirements.
• Strong attention to detail and organizational skills.
• Excellent communication and follow-up skills.
• Ability to manage multiple tasks and meet deadlines.

Responsabilidades

• Manage end-to-end provider credentialing and re-credentialing processes using the Medallion platform.
• Coordinate and process provider enrollment applications with commercial and government payers (e.g., Medicare, Medicaid, and private insurers).
• Maintain accurate and up-to-date provider records within Medallion and internal systems.
• Track application status, follow up with payers, and resolve delays or discrepancies.
• Ensure compliance with regulatory standards, payer requirements, and organizational policies.
• Verify provider credentials including licenses, certifications, malpractice insurance, and work history.
• Prepare and submit credentialing packets and enrollment applications.
• Communicate with providers to obtain required documentation and updates.
• Monitor expiration dates and initiate recredentialing cycles proactively.
• Generate reports and maintain audit-ready documentation.
• Collaborate with internal departments such as billing, compliance, and HR.

Conhecimentos

Attention to detail

Organizational skills

Communication skills

Time management

Customer service

Provider relations

Formação académica

High school diploma or equivalent

Associate's or Bachelor's degree preferred

Ferramentas

Medallion platform

Payer enrollment tools

Descrição da oferta de emprego

Senior PsychCare in Houston, TX is seeking a Credentialing and Enrollment Specialist to manage provider credentialing, re-credentialing, and payer enrollment using the Medallion platform. This role ensures that healthcare providers are properly credentialed and enrolled with insurance networks in a timely and compliant manner.

The position involves end-to-end credentialing, coordinating with payers including Medicare/Medicaid, maintaining records, and generating audit-ready documentation in a