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.