What are the responsibilities and job description for the Credentialing Specialist position at CLS Health?
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
Required
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.
- 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.
- 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.
- 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.
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.
- 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.