Physician Credentialing Specialist
HybridHouston, Texas, United States
Job Summary
Process initial and re-credentialing applications for physicians and advanced practice providers across all TRP entities. Conduct primary source verification of education, licensure, board certification, and malpractice history through NPDB, ABMS, and FSMB. Maintain complete, audit-ready provider files and coordinate hospital privileging applications across affiliated facilities. Track expirables including medical licenses and DEA registrations to prevent lapses. Serve as primary liaison with hospital medical staff offices and health plans while completing payer enrollment applications for Medicare, Medicaid, and commercial plans. Maintain the credentialing database, prepare verification summaries for committee review, and respond to external verification requests. Partner with recruitment and billing teams to align credentialing timelines with provider start dates.
Required Qualifications
- High school diploma or equivalent
- Associate's or Bachelor's degree in Healthcare Administration, Business, or a related field
- Minimum of two (2) years of provider credentialing experience in a medical group, hospital, health system, or managed care setting
- Working knowledge of NCQA, CMS, The Joint Commission, and Texas Medical Board credentialing, privileging, and enrollment standards
- Experience with credentialing software and provider data management systems
- Familiarity with CAQH, PECOS, NPPES, NPDB, and Texas Medicaid enrollment portals
- Exceptional attention to detail with proven ability to manage multiple applications and deadlines simultaneously
- Proficiency in Microsoft Office (Excel, Word, Outlook)
- Excellent written and verbal communication skills for coordination with physicians, medical staff offices, and payers
- Demonstrated discretion in handling sensitive and confidential provider information
Desired Qualifications
- CPCS (Certified Provider Credentialing Specialist) or CPMSM (Certified Professional Medical Services Management) through NAMSS
- willingness to obtain CPCS or CPMSM certification
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