Credentialing Specialist Job at Cole Health, Spring, Montgomery County, TX

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  • Cole Health
  • Spring, Montgomery County, TX

Job Description

Schedule: Monday through Friday either 8am-5pm or 9am-6pm

Pay Rate: $20-$22/hr (depending on experience)

REQUIREMENT: Bilingual English/Spanish preferred

Location: Hybrid Remote/In-Clinic or Fully Remote


Clinic Location: 16835 Deer Creek Drive, Spring, TX 77379

Company Website:

Job Description: Clinical Specialist

The Credentialing Specialist is responsible for managing the credentialing and re-credentialing process for licensed therapists - including Speech-Language Pathologists (SLPs), Occupational Therapists (OTs), and Physical Therapists (PTs) - ensuring compliance with regulatory, accreditation, and organizational standards. This role verifies provider qualifications, licenses, certifications, and work history to support patient safety, risk management, and payer enrollment requirements.

Key Responsibilities
  • Process initial credentialing and re-credentialing applications for speech, occupational, and physical therapists
  • Perform primary source verification of state licenses, national certifications (e.g., ASHA CCC-SLP, NBCOT, NPTE), education, clinical training, malpractice history, and work references
  • Maintain accurate and up-to-date provider files in credentialing software/databases (e.g., CAQH, Symplr, MD-Staff)
  • Track and manage expiration dates for licenses, certifications, CEUs, and liability insurance coverage; proactively initiate renewal processes
  • Coordinate with clinical operations, insurance payers, and facility/agency partners to complete enrollment and privileging
  • Ensure compliance with NCQA, URAC, Joint Commission, CMS, state licensing boards, and payer-specific requirements
  • Prepare credentialing files and reports for internal review and audits
  • Communicate with therapists to obtain missing documentation or clarify discrepancies
  • Respond to inquiries from internal departments, payers, and external agencies regarding credentialing status
  • Maintain confidentiality of sensitive provider information in accordance with HIPAA
  • Assist with internal and external audits related to credentialing compliance
  • Monitor state-specific licensure requirements across multiple jurisdictions if supporting multi-state practice or telehealth therapy services
Required Qualifications
  • High school diploma or equivalent required; associate or bachelor's degree preferred
  • 2+ years of experience in credentialing, healthcare administration, or a therapy/rehab services setting
  • Familiarity with credentialing software and databases
  • Strong understanding of credentialing standards (NCQA, URAC, Joint Commission) and therapy-specific licensure/certification bodies (state PT/OT/SLP boards, ASHA, NBCOT, FSBPT)
  • Excellent organizational skills and high attention to detail
  • Strong written and verbal communication skills
  • Ability to manage multiple priorities and meet deadlines
  • Proficiency in Microsoft Office (Excel, Word, Outlook)
Preferred Qualifications
  • Certified Provider Credentialing Specialist (CPCS) certification
  • Experience with payer enrollment processes for rehab/therapy services
  • Experience credentialing across multiple states (for multi-state or telehealth practices)
  • Knowledge of HIPAA and healthcare compliance regulations
Work Environment
  • Office-based, hybrid, or fully remote depending on organization
  • May require occasional overtime during audit periods or high-volume credentialing cycles

Job Tags

Work at office, Remote work, Monday to Friday

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