Credentialing & Provider Enrollment Specialist

Job Title:Credentialing & Provider Enrollment Specialist

Supervisor:Business Office Director

Texas Hearing Institute (THI) Houston TX (On-site)

Schedule:Monday Thursday: 7:30 am 5:30 pm Friday: 7:30 am 3:00 pm 40 hours/week

Compensation:$23-$25

About Us

Texas Hearing Institute is a Houston-based nonprofit dedicated to serving individuals with hearing loss. Our programs include audiology speech therapy family services and the Melinda Webb School. The Business Office team supports all of these programs by keeping operations running smoothly and the organizations billing and credentialing accurate.

Position Summary

We are looking for an experienced Credentialing & Provider Enrollment Specialist to oversee all aspects of provider credentialing enrollment recredentialing payer contracting support and regulatory compliance. This position serves as the primary liaison between THI providers and commercial and government payers to ensure providers remain credentialed enrolled and eligible for reimbursement. This role will provide front desk coverage only as needed to support departmental operations.

What You Will Do

• Complete 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: Medical licenses/ DEA registrations/ Board certifications/ Professional liability insurance/ CPR certifications (if applicable)

• Recredentialing cycles

• Follow up with payers until providers are confirmed in-network.

• Maintain provider enrollment status reports.

• Ensure compliance with payer enrollment requirements.

• Assist with provider contracting activities.

• Coordinate payer participation requests.

• Maintain contract documentation.

• Monitor provider participation status.

• Communicate enrollment or contracting issues to leadership.

• Monitor credentialing and enrollment timelines.

• Identify providers approaching expiration or termination.

• Prepare weekly credentialing reports.

• Maintain accurate documentation for audits.

• Maintain confidentiality in accordance with HIPAA regulations.

What Were Looking For

• High school diploma or equivalent required; associate or bachelor degree preferred

• Minimum 2 years of provider credentialing and enrollment managed care plan medical Staff Services or credentialing verification office.

• Working knowledge of Texas Medicaid (TMHP/PEMS) Medicare (PECOS) CHIP and commercial payer enrollment requirements.

• Experience maintaining CAQH provider profiles.

• Basic understanding of credentialing Joint Commission NCQA and URAC accreditation standards

• Working knowledge of provider contracting and payer enrollment processes.

• Understanding of healthcare regulatory and compliance standards.

• Strong organizational and follow-up skills

Schedule and Compensation

• Monday Thursday: 7:30 am 5:30 pm/ Friday: 7:30 am 3:00 pm

• $23-$25/hr