Senior Provider Enrollment Specialist

Texas Hearing Institute is seeking an experienced Senior Provider Enrollment Specialist to independently manage provider enrollment and credentialing activities from initial application through confirmed effective date. The position oversees government and commercial payer enrollment, recredentialing, revalidations, provider and location changes, payer follow-up, complex issue resolution, contracting support, and regulatory compliance. This position serves as the primary liaison among THI, providers, payers, and revenue cycle leadership to protect provider participation and prevent enrollment-related claim or reimbursement delays. This role will provide front desk coverage only as needed to support departmental operations.

Responsibilities / Duties:

• Independently manage enrollment from application submission through confirmed payer effective date.
• Complete initial credentialing and recredentialing for all providers.
• Submit and monitor provider enrollment applications.
• Complete and track provider, group, facility, and new-location enrollments across government and commercial payers.
• Manage revalidations, demographic updates, reassignment, and change-of-information submissions.
• Resolve stalled, deficient, returned, or complex enrollment cases through persistent payer follow-up and escalation.
• Maintain a master enrollment tracker with application status, aging, barriers, follow-up dates, and confirmed effective dates.
• Identify and escalate enrollment-related revenue risks that may delay claims, billing, or cash collections.
• Coordinate with billing and revenue cycle staff to prevent or resolve enrollment-related claim and reimbursement delays.
• Serve as an internal subject-matter resource for payer enrollment requirements and portal processes.
•          Maintain provider files and credentialing documentation.
•          Maintain CAQH, PECOS, TMHP/PEMS, and other payer portals.
•          Track expiration dates for: Medical licenses/ DEA registrations/ Board certifications/ Professional liability insurance/ CPR certifications (if applicable)
• Recredentialing cycles
• Prepare weekly credentialing reports
• Identify providers approaching expiration or termination.
•           Follow up with payers until providers are confirmed in-network.
•          Maintain provider enrollment status reports.
•          Ensure compliance with payer enrollment requirements.
•          Assist with provider contracting activities.
•          Coordinate payer participation requests.

•          Communicate enrollment or contracting issues to leadership.

     ·   Monitor credentialing and enrollment timelines.

  
  

·      Education and Experience Requirements:

• High school diploma or equivalent required; associate or bachelor degree preferred
• Minimum 5 years of direct provider enrollment and credentialing experience in a provider organization, managed care plan, medical staff services department, or credentialing verification organization; 5-7 years preferred for senior-level placement.
• Working knowledge of Texas Medicaid (TMHP/PEMS), Medicare (PECOS), CHIP, and commercial payer enrollment requirements.
• Experience maintaining CAQH provider profiles.
• Working knowledge of provider contracting and payer enrollment processes.
• Understanding of healthcare regulatory and compliance standards.
• Strong organizational and follow-up skills