Credentialing Specialist at CLS Health PLLC

Webster, Texas, United States -

Full Time

Start Date

Immediate

Expiry Date

11 Jun, 26

Salary

0.0

Posted On

13 Mar, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Credentialing, Payer Enrollment, Attention to Detail, Communication, Problem-Solving, Compliance, Documentation, Provider Onboarding, Medicare, Medicaid, Commercial Insurance, CAQH, PECOS, NPPES, Availity, Multi-Specialty Healthcare

Industry

Hospitals and Health Care

Description

Description About CLS Health CLS Health is a growing healthcare system in Houston, Texas that is taking a different approach to healthcare. We are a physician-led healthcare group that focuses on providing patients with holistic, multispecialty care. We're a dynamic team on a mission to provide better healthcare options for Houstonians! Job Summary The Credentialing Specialist – Payer Insurance Enrollment is responsible for managing the complete enrollment lifecycle for providers with commercial and government payers. This role ensures timely, accurate submission and maintenance of payer applications, supports the onboarding process for newly hired providers, and works closely with payers, internal stakeholders, and provider groups to ensure compliance and reduce reimbursement delays. The ideal candidate is detail-oriented, deadline-driven, and highly organized, with strong communication and problem-solving skills. Job responsibilities: Payer Enrollment Prepare, submit, and track provider enrollment applications for Medicare, Medicaid, and commercial insurance plans. Maintain complete, accurate, and updated CAQH profiles for all providers. Monitor enrollment statuses and proactively follow up with payers to resolve outstanding issues or delays. Manage revalidations, recredentialing timelines, and ongoing monitoring to ensure continuous participation with payers. Coordinate payer demographic updates, changes in practice locations, reassignment of benefits, and terminations. Provider Onboarding & Support Collaborate with HR, and Medical Staff Services to ensure seamless credentialing and payer enrollment during provider onboarding. Request and validate provider documentation needed for enrollment (licenses, DEA, CV, board certifications, NPI, malpractice, etc.). Serve as a resource for providers regarding enrollment status, payer requirements, and documentation needs. Compliance & Documentation Maintain accurate records in the credentialing/enrollment system (e.g., Availity, PECOS, NPPES, CAQH, internal databases). Ensure compliance with state, federal, and payer-specific regulations and deadlines. Protect confidential provider and organizational information in accordance with HIPAA and internal policies. Cross-Functional Collaboration Partner with Revenue Cycle, Finance, and Operations to support timely reimbursement and identify payer-related barriers. Communicate enrollment timelines and impacts to internal stakeholders. Assist with audits, reporting, and quality improvement initiatives as needed. Requirements Required High school diploma or equivalent. 2+ years of experience in provider credentialing, payer enrollment Working knowledge of Medicare/Medicaid processes and commercial payer requirements. Experience with PECOS, NPPES, CAQH, Availity, and similar platforms. Strong attention to detail, ability to manage multiple deadlines, and excellent follow-up skills. Preferred Associate’s or Bachelor’s degree in Healthcare Administration or related field. CPCS or CPMSM certification (or willingness to obtain). Experience in a multi-site or multi-specialty healthcare organization.

Responsibilities

The Credentialing Specialist is responsible for managing the enrollment lifecycle for providers with payers, ensuring timely and accurate submissions. This role involves collaborating with various stakeholders to support provider onboarding and compliance.