Revenue Cycle Credentialing Specialist

One Behavioral Health and Alara Healthcare provide comprehensive outpatient and inpatient behavioral health services to adults and children throughout the Houston area. As we continue to expand, we are seeking a highly organized and detail-oriented Credentialing Specialist to ensure provider compliance, enhance operational efficiency, and maintain the highest standards of patient care.

Role Overview

The Credentialing Specialist will manage the full lifecycle of provider credentialing and re-credentialing across multiple insurance networks, payers, and credentialing platforms. This position requires a proactive professional with exceptional attention to detail and strong follow-up abilities to ensure continuous regulatory compliance, uninterrupted provider participation, and timely billing and authorization processes. The role is essential in supporting operational stability and accurate reimbursement.

Key ResponsibilitiesCredentialing & Compliance

• Maintain, organize, and routinely update provider credentialing files for both commercial and government payers.
• Oversee and manage CAQH profiles to ensure compliance with CMS regulations and payer-specific requirements.
• Process initial credentialing, re-credentialing, and enrollment applications for Medicare, Medicaid, and private insurance plans.
• Handle applications, renewals, and documentation related to professional licenses, DEA registrations, and controlled substance permits.
• Complete required provider revalidation processes for regulatory and government agencies within established deadlines.
• Coordinate hospital credentialing activities, manage provider privileges, and maintain active affiliations.

Collaboration & Operational Support

• Partner with the Revenue Cycle Director and Billing Team to resolve credentialing-related denials, payer concerns, and authorization delays.
• Ensure provider information remains accurate and consistent across CAQH, PECOS, NPPES, CMS databases, and internal systems.
• Maintain a centralized credentialing tracker including credential status, expiration dates, payer participation, and system access details.
• Provide administrative support for credentialing audits, compliance reviews, and regulatory documentation as needed.

Job Type: Full-time

Pay: Rs45,000.00 - Rs70,000.00 per month

Ability to commute/relocate:

• Wapda Town: Reliably commute or planning to relocate before starting work (Required)

Application Question(s):

• Willing to work in the USA time?

Experience:

• Medical Billing: 1 year (Preferred)

Language:

• English (Required)

Work Location: In person