DRISCOLL HEALTH PLAN·Corpus Christi, Texas
The specialist oversees the credentialing matrix and manages the enrollment and revalidation process for providers with government and commercial payors. They act as a liaison between providers and administration to ensure financial viability and adherence to reimbursement guidelines.
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The CME Credentialing specialist will oversee the credentialing matrix and assist with progress to get providers credentialed with Government payor first.
She will be a liaison to administrative assistants as well as providers with regards to the accurate and complete credentialing and revalidation process to ensure the financial viability of the organization in accordance with State & Federal reimbursement guidelines.
She will also assist with credentialing commercial insurance carriers for all providers within CPSST practicing.
Duties include but are not limited to ensuring accurate and timely update of addresses with payors.
Enroll providers into Medicare, Medicaid and commercial insurance plans under CPSST and do revalidations to include updating locations and documentation.
Essential
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable an individual with disabilities to perform the essential functions. This job description is not intended to be all-inclusive; the employee will perform other reasonably related business duties as assigned by the immediate supervisor and/or administration as required. Always maintains utmost level of confidentiality. Adheres to DCH policies and procedures. Demonstrates business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines. Review documents submitted by providers (doctors and NP’s) for accurate information. Assist Provider with credentialing revalidations as needed for CPSST providers. Interact with CBO Director and Coding Manager frequently or as needed to ensure compliance and accuracy in credentialing role. Follow up with CBO Director and coding manager on problems and delays in credentialing. Direct report to CBO Manager regarding job responsibilities/functions and DCH policies. Interacts with providers Demonstrates understanding of security and confidentiality of data and information. Always maintains a professional demeanor. Assists in training of other team members and acts as a resource for other staff members. Maintains flexibility in scheduling to ensure optimal departmental operations. Effectively demonstrates DCH philosophy, values, and mission as evidenced by interactions with others. Maintains and ensures confidentiality of financial patient records and follows HIPPA regulations. Performs assignments and other work-related tasks as designated in a timely and professional manner. Responds to all inquiries in a timely and professional manner. Perform any other duty as assigned by the Director or Manager. Education and/or Experience: High school diploma or general education degree (GED) Three or more years of related work experience in credentialing process
Candidates must have a high school diploma or GED and at least three years of related experience in the credentialing process. The role requires a strong understanding of security, confidentiality, and professional demeanor.
Market context
Administrative roles in Texas often draw steady demand in schools and healthcare settings because they support daily operations, compliance, and communication. These positions can be competitive when employers want candidates with a bachelor’s degree, directly related experience, and preferred credentials such as ACRP or SOCRA certification and Spanish bilingual skills. Review the AI-summarized requirements and benefits on this platform to save research time, then tailor your application to show relevant administrative experience and language or certification strengths.
