Credentialing Specialist

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 Insurance Credentialing Specialist is responsible for managing the credentialing and re-credentialing process for healthcare providers with insurance companies, government programs, and other payer organizations. This role ensures providers are properly enrolled, compliant, and eligible for reimbursement.

Key Responsibilities

Coordinate and manage provider credentialing and re-credentialing with commercial insurers, Medicare, and Medicaid

Prepare and submit credentialing applications and supporting documentation

Maintain accurate provider records in credentialing databases and systems

Track application status and follow up with insurance companies to ensure timely approvals

Ensure compliance with regulatory and accreditation standards (e.g., CMS, NCQA)

Update provider information such as licenses, certifications, malpractice insurance, and hospital privileges

Manage payer enrollments, terminations, and updates

Serve as a liaison between providers, practice management, and insurance companies

Monitor expiration dates and ensure timely renewals

Assist with audits and maintain credentialing files for review

Key Skills

Time management and multitasking

Analytical and problem-solving skills

Data entry accuracy

Knowledge of healthcare terminology

Ability to work independently and meet deadlines

Requirements

• •Experience with CAQH enrollment and maintenance.
• •Knowledge of Medicare and Medicaid credentialing processes preferred.
• •Understanding of healthcare regulations, accreditation standards, and provider credentialing requirements.
• •Strong attention to detail with a high degree of accuracy in documentation and record management.
• •Excellent written and verbal communication skills, with strong interpersonal abilities.
• •Proficiency in credentialing software, databases, and Microsoft Office applications.
• •Familiarity with medical terminology preferred.
• •Ability to manage multiple projects, prioritize tasks, and meet deadlines in a fast-paced environment.