Senior Provider Enrollment Specialist

TEXAS HEARING INSTITUTE; Houston (TX); On-site; USD 70,000 - 100,000; Full time

Job summary

TEXAS HEARING INSTITUTE seeks an experienced Senior Provider Enrollment Specialist to independently manage provider enrollment and credentialing from initial application through confirmed effective date.

The role oversees government and commercial payer enrollment, recredentialing, and portal processes, serving as the liaison among THI, providers, payers, and revenue cycle leadership. Front desk coverage may be required.

Qualifications

• Minimum 5 years of provider enrollment and credentialing experience.
• Knowledge of TMHP/PEMS, Medicare PECOS, CHIP, and commercial payer enrollment requirements.
• Experience maintaining CAQH provider profiles.
• Understanding of provider contracting and payer enrollment processes.
• Strong organizational and follow-up skills.

Responsibilities

• Manage enrollment from application submission through payers' effective date.
• Complete initial credentialing and recredentialing for all providers.
• Submit and monitor enrollment applications with government and commercial payers.
• Maintain a master enrollment tracker with status, aging, and deadlines.
• Coordinate with billing to prevent enrollment-related delays.
• Provide internal SME on enrollment requirements and portals.

Education

High school diploma or equivalent

Associate or bachelor’s degree preferred

5 years of direct provider enrollment and credentialing experience

Knowledge of TMHP/PEMS, Medicare PECOS, CHIP, and commercial payer enrollment requirements

CAQH provider profiles experience

Provider contracting and payer enrollment processes

Healthcare regulatory and compliance standards

Strong organizational and follow-up skills

Tools

CAQH

PECOS

TMHP/PEMS

Payer portals knowledge

Job description

Texas Hearing Institute is seeking an experienced SeniorProvider Enrollment Specialist to independently manage provider enrollment andcredentialing activities from initial application through confirmed effectivedate. The position oversees government and commercial payer enrollment,recredentialing, revalidations, provider and location changes, payer follow-up,andrevenue cycle leadership to protect provider participation and preventenrollment-related claim or reimbursement delays. Thisposition serves as the primary liaison among THI, providers, payers, andrevenue cycle leadership to protect provider participation and preventenrollment-related claim or reimbursement delays. This role will provide frontdesk coverage only as needed to support departmental operations.

Responsibilities / Duties:

• Independentlymanage enrollment from application submission through confirmed payereffective date.
• Complete initial credentialing and recredentialing for all providers.
• Submit and monitor provider enrollment applications.
• Completeand track provider, group, facility, and new-location enrollments acrossgovernment and commercial payers.
• Managerevalidations, demographic updates, reassignment, andchange-of-information submissions.
• Resolvestalled, deficient, returned, or complex enrollment cases throughpersistent payer follow-up and escalation.
• Maintaina master enrollment tracker with application status, aging, barriers,follow-up dates, and confirmed effective dates.
• Identifyand escalation enrollment-related revenue risks that may delay claims,billing, or cash collections.
• Coordinatewith billing and revenue cycle staff to prevent or resolveenrollment-related claim and reimbursement delays.
• Serveas an internal subject-matter resource for payer enrollment requirementsand portal processes.
• Maintainprovider files and credentialing documentation.
• MaintainCAQH, PECOS, TMHP/PEMS, and other payer portals.
• Trackexpiration dates for: Medical licenses/ DEA registrations/ Board certifications/Professional liability insurance/ CPR certifications (if applicable)
• Recredentialingcycles
• Prepare weekly credentialing reports
• Identify providers approaching expiration or termination.
• Followup with payers until providers are confirmed in-network.
• Maintainprovider enrollment status reports.
• Ensure compliance with payer enrollment requirements.
• Assist with provider contracting activities.
• Coordinate payer participation requests.
• Communicate enrollment or contracting issues to leadership.
• Monitor credentialing and enrollment timelines.

Education and Experience Requirements:

• Highschool diploma or equivalent required; associate or bachelor degreepreferred
• Minimum5 years of direct provider enrollment and credentialing experience in aprovider organization, managed care plan, medical staff servicesdepartment, or credentialing verification organization; 5-7 yearspreferred for senior-level placement.
• Workingknowledge of Texas Medicaid (TMHP/PEMS), Medicare (PECOS), CHIP, andcommercial payer enrollment requirements.
• Experiencemaintaining CAQH provider profiles.
• Workingknowledge of provider contracting and payer enrollment processes.
• Understandingof healthcare regulatory and compliance standards.
• Strongorganizational and follow-up skills