Credentials Specialist
hace 5 días
Houston
Job Description We’re Looking for a Credentialing Superstar! Do you love staying organized, solving problems, checking items off a list, and keeping important processes moving? If so, you may be exactly who we’re looking for! Texas Care is looking for a friendly, dependable, and detail-oriented Credentialing Specialist to join our growing team. Texas Care works with behavioral healthcare providers, franchise owners, and organizations across Texas—and credentialing is a vital part of making sure they can serve their communities. In this position, you will guide providers and owners through credentialing and enrollment, keep applications organized, follow up with insurance companies, and celebrate every approval along the way! You will also serve as the go-to person for credentialing questions, provide helpful updates, and make a complicated process feel much easier for everyone involved. We’re looking for someone who takes initiative, communicates well, and doesn’t let an application sit untouched. You should enjoy working with people, tracking details, following up consistently, and finding solutions when an enrollment hits a roadblock. Experience with healthcare credentialing is strongly preferred. Familiarity with TMHP, Texas Medicaid managed-care organizations, Medicare, CAQH, NPPES, and behavioral-health enrollment would be especially valuable. If you’re someone who says, “I’ll take care of it,” and truly follows it through to completion, we would love to meet you. Join Texas Care and help us remove barriers, support our providers, and strengthen access to behavioral healthcare throughout Texas! Position Summary The Credentialing Specialist is responsible for coordinating and maintaining credentialing, recredentialing, and payer enrollment activities for Texas Care. This includes credentialing Texas Care’s individual healthcare providers, all locations throughout Texas, franchise-owned entities, and franchise locations. The Credentialing Specialist serves as the primary point of contact for credentialing and enrollment questions. This position works closely with providers, franchise owners, organizational leadership, internal departments, insurance companies, government agencies, and outsourced credentialing vendors to ensure applications are complete, accurate, submitted promptly, and routinely followed through to completion. Essential Duties and Responsibilities Organizational Credentialing and Enrollment • Manage credentialing, recredentialing, and enrollment activities for Texas Care., • Credential and enroll individual providers working under Texas Care., • Coordinate credentialing and enrollment for franchise-owned entities and individual franchise locations., • Assist organizations operating under an MSA with required credentialing and payer-enrollment processes., • Complete and monitor applications for Medicaid, Medicare, managed-care organizations, commercial insurance plans, and other applicable payers., • Ensure providers and entities are enrolled with all applicable health plans available within their service areas., • Coordinate enrollment for new locations, ownership changes, provider additions, demographic updates, and other organizational changes. Application Management and Follow-Up • Prepare, submit, and track credentialing and enrollment applications., • Routinely check application statuses with payers, government agencies, and credentialing organizations., • Follow up on pending applications, missing information, corrections, development requests, and additional documentation., • Maintain a detailed tracking system showing submission dates, reference numbers, payer status, outstanding items, effective dates, revalidation dates, and anticipated completion dates., • Escalate enrollment delays, denials, or compliance concerns to leadership when appropriate., • Verify that approved enrollments are effective and accurately connected to the correct provider, entity, service location, tax identification number, and billing information. Outsourced Credentialing Coordination • Serve as the primary liaison between Texas Care and any outsourced credentialing company., • Provide the credentialing agency with accurate and timely documents, provider information, signatures, ownership information, and other required materials., • Assist in resolving missing items, application discrepancies, payer requests, and enrollment barriers., • Monitor the outsourced agency’s work to ensure applications are progressing and deadlines are met., • Maintain internal records of all applications and correspondence, including work completed by an outside credentialing agency., • Provide leadership and franchise owners with updates regarding outsourced credentialing activities. Franchisee and MSA Support • Train franchise owners, staff members, and location owners on credentialing and enrollment requirements., • Explain required documents, application processes, expected timelines, provider responsibilities, and payer-specific requirements., • Communicate directly with owners regarding application status, missing documentation, next steps, approvals, and delays., • Provide ongoing guidance and answer credentialing-related questions in a professional and timely manner., • Help franchisees understand the distinction between organizational enrollment, location enrollment, and individual provider credentialing., • Support locations as they transition from enrollment under Texas Care to independently credentialed status, when applicable. Document and Compliance Management • Collect, review, organize, and securely maintain credentialing documentation., • Ensure credentialing files contain current licenses, certifications, education records, work histories, professional liability insurance, identification documents, disclosures, ownership information, W-9 forms, NPIs, taxonomy information, CAQH records, and other required materials., • Monitor expiration and renewal dates for licenses, certifications, insurance policies, CAQH attestations, recredentialing, revalidation, and payer agreements., • Ensure information remains consistent across CAQH, NPPES, TMHP, Medicare, managed-care plans, internal systems, and submitted applications., • Maintain confidentiality and comply with HIPAA, payer requirements, organizational policies, and all applicable state and federal regulations., • Identify incomplete, inconsistent, or expired documentation and promptly request corrections., • Assist and submit yearly attestation requirements per each MCO. Communication and Teamwork • Serve as the central point of contact for credentialing and enrollment questions., • Communicate clearly and professionally with providers, owners, payer representatives, vendors, and internal staff., • Provide routine status reports to leadership and applicable franchise owners., • Work collaboratively with operations, clinical, billing, compliance, human resources, administrative staff, and other departments., • Participate in team meetings and contribute to improving credentialing processes and workflows., • Notify appropriate departments when providers, entities, or locations become effective with a payer., • Assist other staff members as needed to support Texas Care’s overall operations and growth. Required Qualifications • High school diploma or equivalent required; associate or bachelor’s degree preferred., • Previous experience in healthcare credentialing, provider enrollment, medical administration, or a related field strongly preferred., • Knowledge of provider credentialing, payer enrollment, CAQH, NPPES, Medicaid, Medicare, and managed-care processes preferred., • Strong organizational skills and exceptional attention to detail., • Ability to manage multiple providers, entities, locations, applications, and deadlines simultaneously., • Strong written and verbal communication skills., • Ability to follow up consistently and professionally with providers, owners, payers, and outside agencies., • Ability to work independently while contributing effectively as part of a team., • Proficiency with Microsoft Office, Google Workspace, spreadsheets, document-management systems, and electronic tracking systems., • Ability to handle confidential and sensitive information appropriately. Preferred Qualifications • Experience with Texas Medicaid and Healthcare Partnership (TMHP) enrollment., • Experience working with Texas Medicaid managed-care organizations., • Experience credentialing behavioral-health providers and organizations., • Familiarity with behavioral-health provider types, including psychiatrists, nurse practitioners, licensed clinicians, and qualified mental health professionals., • Experience supporting multi-location healthcare organizations or franchise networks., • Certified Provider Credentialing Specialist (CPCS) certification or similar credential is beneficial but not required. Core Competencies • Organization and document management, • Accuracy and attention to detail, • Accountability and consistent follow-through, • Professional communication, • Problem-solving and initiative, • Deadline and priority management, • Confidentiality and ethical conduct, • Customer service and franchisee support, • Collaboration and teamwork, • Adaptability in a growing organization Performance Expectations The Credentialing Specialist is expected to: • Maintain accurate and current credentialing records., • Submit complete applications within established timeframes., • Monitor every application through final approval or resolution., • Respond promptly to credentialing questions and requests., • Provide owners and leadership with routine, accurate status updates., • Proactively identify missing information, upcoming expirations, and enrollment barriers., • Maintain professional and cooperative relationships with all internal and external stakeholders., • Help ensure that providers, entities, and locations do not deliver or bill for services before required enrollment and effective dates are confirmed. Equal Employment Opportunity Texas Care is committed to providing equal employment opportunities. Employment decisions are made without regard to race, color, religion, sex, national origin, age, disability, veteran status, or any other status protected by applicable law. \nCompany Description Texas Care is a leading behavioral health care organization and franchisor with a growing statewide network of clinics. We specialize in community-based mental health rehabilitation, targeted case management, and comprehensive support services. Our team is dedicated to ensuring consistent, high-quality care and compliance across all locations while staying true to our mission: Helping Texans Heal. We believe in empowering our staff to make a meaningful difference in the lives of the individuals and families we serve. Texas Care is a leading behavioral health care organization and franchisor with a growing statewide network of clinics. We specialize in community-based mental health rehabilitation, targeted case management, and comprehensive support services. Our team is dedicated to ensuring consistent, high-quality care and compliance across all locations while staying true to our mission: Helping Texans Heal. We believe in empowering our staff to make a meaningful difference in the lives of the individuals and families we serve.
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