Senior Credentialing Specialist

Themesoft Inc.; Houston (TX); On-site; USD 65,000 - 95,000; Full time

Job summary

The Senior Credentialing Specialist at Themesoft Inc. will oversee the end-to-end credentialing lifecycle, including PSV, provider onboarding, and payer enrolment.

You will ensure regulatory compliance and maintain provider data accuracy while supporting committee reviews. Ideal candidates bring 5–8 years in credentialing, with strong CAQH experience and knowledge of NCQA, CMS, and Joint Commission standards, plus hands-on use of credentialing platforms and a background in healthcare payers or

Qualifications

• 5–8 years of provider credentialing and CVO operations experience.
• Strong PSV, CAQH, provider enrolment, and re-credentialing experience.
• Knowledge of NCQA, CMS, Joint Commission, OIG, and SAM compliance requirements.
• Experience verifying provider licenses, education, certifications, work history, malpractice coverage, and sanctions screening.
• Hands-on experience with credentialing platforms.

Responsibilities

• Manage end-to-end credentialing lifecycle from onboarding to re-credentialing and payer enrolment.
• Perform Primary Source Verification (PSV) and ensure accuracy of provider data.
• Maintain regulatory compliance with NCQA, CMS, Joint Commission, OIG, and SAM standards.
• Support committee reviews and SLA adherence; manage credentialing files.
• Collaborate with payers and providers to expedite enrolment processes.

Skills

Provider credentialing

PSV/CAQH

Regulatory compliance

Credentialing platforms

SLA management

Onboarding

Team collaboration

CVO operations

Education

CPCS

CPMSM

Tools

CAQH ProView

Provider enrolment systems

Job description

We are seeking an experienced Senior Credentialing Specialist with expertise in CVO (Credentials Verification Organization) operations, Provider Credentialing, and Provider Enrolment. The candidate will be responsible for managing the end-to-end credentialing lifecycle, including Primary Source Verification (PSV), regulatory compliance, provider onboarding, re-credentialing, and payer enrolment activities.

Key Requirements:

• 5 - 8 years of experience in provider credentialing and CVO operations.
• Strong experience in PSV, CAQH, provider enrolment, and re-credentialing.
• Knowledge of NCQA, CMS, Joint Commission, OIG, and SAM compliance requirements.
• Experience verifying provider licenses, education, certifications, work history, malpractice coverage, and sanctions screening
• Hands-on experience with credentialing platforms
• Ability to manage credentialing files, support committee reviews, maintain provider data, and ensure SLA adherence
• Preferred Background: Candidates from healthcare payers, hospitals, health systems, managed care organizations, or credentialing service providers with relevant certifications (CPCS, CPMSM) are highly preferred