Credentialing Specialist (Home Health & Behavioral Health)

Seeking an experienced Credentialing Specialist responsible for managing all aspects of provider credentialing, recredentialing, enrollment, and contracting for both Home Health and Behavioral Health service lines. The Credentialing Specialist will ensure compliance with federal, state, payer, accreditation, and organizational requirements while facilitating timely provider enrollment and reimbursement. Essential Duties and Responsibilities Provider Credentialing & Enrollment Coordinate initial credentialing and recredentialing processes for Home Health and Behavioral Health providers. Prepare, submit, track, and maintain provider enrollment applications with Medicare, Medicaid, Managed Care Organizations (MCOs), commercial insurance carriers, and other payers. Verify provider qualifications, licenses, certifications, education, training, work history, malpractice coverage, and sanctions. Monitor credential expiration dates and maintain compliance records. Maintain accurate provider files and credentialing databases. Contracting Support Assist with provider contracting and payer network participation applications. Track contract status, follow up with payers, and resolve enrollment delays. Coordinate communication between providers, payers, and organizational leadership regarding credentialing and contracting matters. Maintain records of executed agreements and credentialing approvals. Regulatory Compliance Ensure compliance with CMS, Medicaid, Medicare Advantage, Home Health, Behavioral Health, and state licensing requirements. Monitor regulatory changes affecting provider enrollment and credentialing processes. Assist with audits, surveys, and accreditation reviews. Maintain confidentiality and compliance with HIPAA regulations. Claims and Revenue Cycle Support Collaborate with billing and revenue cycle teams to resolve credentialing-related claim denials. Research enrollment issues impacting reimbursement. Track provider effective dates and ensure accurate payer system updates. Assist in resolving claims held due to credentialing or contracting issues. Reporting and Documentation Generate credentialing status reports for leadership. Maintain credentialing calendars and renewal schedules. Document all payer communications, application submissions, and follow-up activities. Prepare reports on provider enrollment status, contract execution, and outstanding credentialing requirements. Qualifications Required Minimum 2 years of healthcare credentialing experience. Experience credentialing providers for both Home Health and Behavioral Health services. Knowledge of Medicare, Medicaid, Managed Care, and commercial payer enrollment processes. Familiarity with CAQH, PECOS, NPPES, TMHP, and state Medicaid enrollment systems. Strong organizational, analytical, and follow-up skills. Proficiency with Microsoft Office and credentialing software systems. Preferred Experience with Texas Medicaid and Texas Health and Human Services credentialing requirements. Knowledge of Home Health agency enrollment and Behavioral Health provider contracting. CPC, CPMSM, CPCS, or related credentialing certification. Experience supporting multi-provider healthcare organizations. Key Competencies Attention to detail Regulatory compliance knowledge Contract management support Problem-solving and issue resolution Communication and relationship management Project and deadline management Work Environment This position may be performed remotely, hybrid, or onsite and requires regular communication with providers, payers, government agencies, and internal departments to ensure timely credentialing, contracting, and reimbursement.