Credentialing and Enrollment Specialist

Description

Credentialing and Enrollment Specialist (Medallion Platform)- Houston, TX 77027

About Us:

Senior Psych Care provides fully integrative behavioral health services to the long-term care patient, at their facility. 

Job Summary:

The Credentialing and Enrollment Specialist is responsible for managing provider credentialing, re-credentialing, and payer enrollment processes using the Medallion credentialing platform. This role ensures that healthcare providers are properly credentialed and enrolled with insurance networks in a timely and compliant manner.

Key Responsibilities:

• Manage end-to-end provider credentialing and re-credentialing processes using the Medallion platform
• Coordinate and process provider enrollment applications with commercial and government payers (e.g., Medicare, Medicaid, and private insurers)
• Maintain accurate and up-to-date provider records within Medallion and internal systems
• Track application status, follow up with payers, and resolve delays or discrepancies
• Ensure compliance with regulatory standards, payer requirements, and organizational policies
• Verify provider credentials including licenses, certifications, malpractice insurance, and work history
• Prepare and submit credentialing packets and enrollment applications
• Communicate with providers to obtain required documentation and updates
• Monitor expiration dates and initiate recredentialing cycles proactively
• Generate reports and maintain audit-ready documentation
• Collaborate with internal departments such as billing, compliance, and HR

Required Qualifications:

• High school diploma or equivalent (Associate’s or Bachelor’s degree preferred)
• 2+ years of experience in provider credentialing and enrollment
• Hands-on experience with the Medallion credentialing platform (strongly preferred)
• Knowledge of payer enrollment processes, CAQH, and healthcare regulations
• Familiarity with Medicare, Medicaid, and commercial insurance requirements
• Strong attention to detail and organizational skills
• Excellent communication and follow-up skills
• Ability to manage multiple tasks and meet deadlines

Preferred Qualifications:

• Certification such as CPCS (Certified Provider Credentialing Specialist) or CPMSM
• Experience working in a healthcare organization, medical group, or managed care environment
• Experience with credentialing audits and compliance standards (e.g., NCQA, Joint Commission)

Key Skills:

• Proficiency in Medallion platform and credentialing tools
• Data entry and record management accuracy
• Problem-solving and issue resolution
• Time management and prioritization
• Customer service and provider relations

Work Environment:

• Office-based
• Fast-paced healthcare administrative setting

Job Summary:
The Credentialing and Enrollment Specialist is responsible for managing provider credentialing, recredentialing, and payer enrollment processes using the Medallion credentialing platform. This role ensures that healthcare providers are properly credentialed and enrolled with insurance networks in a timely and compliant manner.

What We Offer:

• Competitive salary, commensurate with experience
• Comprehensive benefits package including:
• Medical
• Dental
• Vision
• Short and Long Term Disability
• Life Insurance
• 401 (k)
• Paid Time Off and Paid Holidays