Credentialing and Enrollment Specialist

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