Credentialing Specialist
Share
Job Location:
Flower Mound, TX - USA
Monthly Salary:
Not Disclosed
Posted on:
5 hours ago
Vacancies:
1 Vacancy
Department:
Job Summary
We are seeking a detail-oriented Credentialing Specialist to serve as a vital component of our home office team. This role will be responsible for obtaining verifying and maintaining the credentials licensure and insurance coverage for our clinical staff in Texas and Oklahoma. By ensuring accurate and timely credentialing you will directly support the revenue cycle minimize billing disruptions and ensure our providers are able to serve their communities.
Key Responsibilities
Database Management: Create and maintain comprehensive digital records of provider licensing credentials and malpractice insurance. Manage provider profiles in industry databases (e.g. CAQH PECOS NPPES) with high accuracy.
Proactive Compliance: Monitor expiration dates for licenses DEA certificates board certifications and insurance policies. Issue renew by notifications to staff and management well in advance to prevent coverage lapses.
Verification Liaison: Act as the primary point of contact for external agencies hospitals and commercial payers requesting verification of provider information.
Regulatory Research: Stay current on updated state federal and payer-specific regulations (including NCQA and CMS standards) to ensure organizational policies remain compliant.
Process Optimization: Assist in developing and revising internal credentialing Standard Operating Procedures (SOPs) to improve workflow efficiency and data integrity.
Audit Readiness: Ensure the facility and all staff members maintain continuous compliance to ensure readiness for internal or external audits at any time.
Qualifications :
Required: High School Diploma or GED. Bachelors degree or college coursework in Health Administration Business or a related field.
Preferred: Minimum of 2 years of experience in medical billing credentialing provider enrollment or medical office administration.
Proficiency with provider enrollment platforms (Medicare Medicaid Commercial Payers).
Strong knowledge of medical credentialing policies healthcare regulations and accreditation standards.
Exceptional accuracy in data entry and document verification.
Communicator: Strong verbal and written communication skills with the ability to speak professionally with clinicians and insurance representatives.
Organizer: Ability to meet strict deadlines and prioritize tasks in a fast-paced environment without compromising quality.
- Team Player: Willingness to collaborate with the billing and authorization teams while possessing the self-discipline to work independently.
Remote Work :
No
Employment Type :
Full-time
Key Skills
- Sales Experience
- Crane
- Customer Service
- Communication skills
- Heavy Equipment Operation
- Microsoft Word
- Case Management
- OSHA
- Team Management
- Catheterization
- Microsoft Outlook Calendar
- EHS
About Company
Therapy & Beyond is one of the largest BCBA-owned ABA organizations, founded and led by Dr. Regina Crone, BCBA-D, since 2006. At Therapy & Beyond we approach the needs of each patient both individually and as part of a dynamic interdisciplinary team working with experts in applied beh ... View more
