Credentialing Specialist

Description

About CLS Health:

At CLS Health, we are redefining healthcare delivery. As Houston’s largest physician-owned, physician-led healthcare system, our mission is to provide patient-centered care through innovation and operational excellence. With over 200 providers in 35+ locations and over 50 specialties, we’re building a scalable healthcare system that empowers physicians and delivers unmatched quality and access for patients.

We are Looking for:

The Credentialing Specialist plays a critical role in maintaining compliance and operational efficiency within a healthcare organization by ensuring all healthcare providers are properly credentialed with both internal systems and external insurance payers. This role involves managing the full scope of credentialing and re-credentialing processes, including commercial and government insurance enrollment, provider licensing, and regulatory compliance. The Credentialing Specialist works closely with providers, insurance companies, medical staff, and regulatory agencies to verify qualifications and maintain accurate, up-to-date credentialing records.

Responsibilities:

• Coordinate and manage the credentialing and re-credentialing processes for healthcare providers, including physicians, nurse practitioners, allied health professionals, and other clinical staff.
• Handle insurance credentialing and enrollment processes with commercial payers and government programs (e.g., Medicare, Medicaid), ensuring timely and accurate submission of applications and updates.
• Maintain current knowledge of payer-specific requirements, credentialing timelines, and enrollment policies to avoid delays and ensure ongoing provider eligibility.
• Collect, review, and verify all provider documentation such as state licenses, DEA registrations, board certifications, malpractice insurance, education, training, and work history.
• Conduct primary source verification of credentials and licenses using appropriate systems and databases (e.g., NPPES, CAQH, state licensing boards).
• Track provider participation status with all contracted payers and ensure re-attestation and re-credentialing is completed within required timeframes.
• Maintain and update provider information in credentialing databases and software systems, ensuring all records are accurate, compliant, and audit ready.
• Collaborate with internal departments including human resources, compliance, billing, and clinic operations to ensure seamless onboarding and credentialing of new providers.
• Serve as a liaison between providers and insurance companies to resolve credentialing issues, application denials, or delays.
• Monitor compliance with accreditation, regulatory, and payer requirements related to provider credentialing and enrollment.
• Assist with the onboarding of new providers, ensuring they are credentialed and enrolled before seeing patients.
• Generate reports on credentialing status, expirable (e.g., licenses, certifications), and payer enrollment for leadership and compliance monitoring.
• Identify and implement process improvements to streamline credentialing workflows and reduce turnaround times.
• Perform related duties as assigned.

Full benefits package including:

• 401(k) with company match
• Medical, Dental, Vision, and Life Insurance
• Paid time off
• Disability insurance

Requirements

• At least 2+ years of experience in insurance credentialing required
• Knowledge of healthcare regulations, accreditation standards, and credentialing requirements.
• Strong attention to detail and accuracy in record-keeping.
• Effective communication and interpersonal abilities.
• Proficiency in using credentialing software and databases.
• Familiarity with medical terminology is a plus.