Provider Credentialing & Enrollment Specialist — Part-Time
Apex Integrated Therapy Services, LLC
100% Remote — Texas
Part-Time | W-2
Pay: Starting at $20/hour, based on experience
About Apex
Apex Integrated Therapy Services is a therapist-owned behavioral and allied health private practice serving children, adolescents, adults, and families. Our services include mental health therapy, pediatric and adult speech therapy, evaluations and assessments, and school-based support services.
Join a Growing Therapist-Owned Practice
Apex Integrated Therapy Services is seeking an experienced Provider Credentialing & Enrollment Specialist to manage the full payer credentialing and enrollment lifecycle for our growing outpatient behavioral and allied health practice.
This role goes beyond completing applications. We are looking for someone who understands how to manage Behavioral Health and Allied Health providers from initial credentialing and enrollment through payer approval, network participation, group affiliation, recredentialing, revalidation, and ongoing payer maintenance.
The Specialist will support Apex across commercial insurance plans, Texas Medicaid/TMHP, Medicaid managed care plans, and Medicare, helping ensure our providers remain properly credentialed, enrolled, affiliated, compliant, and ready to bill applicable payers.
Experience supporting an outpatient private practice is strongly preferred, particularly with behavioral/mental health and allied health professionals such as counselors, psychologists, speech-language pathologists, occupational therapists, and physical therapists.
What You'll Do
- Review credentialing and enrollment documentation for newly onboarded Apex providers and identify missing or incomplete information
- Verify and maintain provider licenses, certifications, NPI/NPPES information, taxonomy codes, malpractice coverage, and other required credentialing documentation
- Maintain and monitor provider CAQH profiles and attestations
- Prepare and submit credentialing and enrollment applications for commercial insurance plans, Texas Medicaid/TMHP, Texas Medicaid managed care organizations, and Medicare
- Manage initial credentialing, provider enrollment, recredentialing, revalidation, and ongoing payer maintenance across all applicable payer types
- Complete commercial payer credentialing and enrollment, including provider additions, group affiliations, roster submissions, demographic updates, and network maintenance
- Manage Texas Medicaid/TMHP provider enrollment, including revalidation, provider maintenance, demographic updates, and group/provider affiliations
- Work with Texas Medicaid managed care plans to complete provider enrollment, roster updates, network participation requirements, and ongoing maintenance
- Support Medicare credentialing and enrollment, including PECOS, revalidation, provider updates, service locations, and group affiliations as applicable
- Track all payer applications from submission through approval and effective date
- Conduct timely follow-up with commercial payers, TMHP, Medicaid managed care plans, Medicare, and other payer representatives
- Maintain ongoing communication with payer Provider Relations departments regarding network status, roster requests, enrollment issues, and payer requirements
- Monitor provider licenses, certifications, attestations, credentialing deadlines, recredentialing dates, and revalidation requirements
- Complete payer-required provider maintenance and demographic updates
- Manage provider rosters, group affiliations, service-location changes, provider additions, and terminations
- Verify and document each provider’s network participation and effective date before services are scheduled or billed
- Maintain an accurate, up-to-date Credentialing & Enrollment Dashboard
- Provide timely updates to Apex leadership and operations regarding payer participation, enrollment status, and provider readiness to see insured clients
- Research payer-specific credentialing and enrollment requirements for different provider types and license levels
- Maintain documentation of payer correspondence, approvals, effective dates, deficiencies, and enrollment requirements
- Assist with EFT/ERA enrollment and related payer setup as needed
- Collaborate with billing/revenue cycle functions to investigate and resolve credentialing- or enrollment-related claim denials
- Help identify credentialing or enrollment issues before they result in denied claims, delayed reimbursement, or inappropriate scheduling
Potential Billing & Revenue Cycle Responsibilities
As Apex grows, this position may expand to include medical billing and revenue cycle responsibilities based on the individual's experience, performance, and practice needs.
Future responsibilities may include:
- Insurance eligibility and benefits verification
- Claims submission and claim-status follow-up
- Rejected and denied claim review
- Corrected claims and payer follow-up
- ERA/EOB review and payment posting support
- Accounts receivable follow-up
- Authorization tracking
- Billing-related payer communication
- Revenue cycle reporting and workflow support
Medical billing or revenue cycle experience is preferred but is not required for the initial credentialing and enrollment responsibilities.
What We're Looking For
Required Qualifications
- 2+ years of provider credentialing and payer enrollment experience
- Experience managing the full provider credentialing and enrollment lifecycle
- Experience with initial credentialing and provider enrollment
- Experience with recredentialing and/or revalidation
- Experience with commercial insurance credentialing and enrollment
- Experience with or strong working knowledge of Medicaid policies, provider enrollment requirements, managed care, and revalidation
- Experience maintaining CAQH profiles and attestations
- Knowledge of NPI/NPPES, taxonomy codes, service locations, and provider information maintenance
- Experience with payer portals, provider rosters, and group affiliations
- Experience tracking applications through payer approval and effective date
- Ability to communicate directly with insurance payers and resolve credentialing or enrollment issues
- Strong attention to detail, organization, documentation, and follow-through
- Ability to independently manage multiple providers, payers, applications, and deadlines
- Ability to work effectively in a remote environment
Strongly Preferred Qualifications
- 3+ years of provider credentialing and enrollment experience
- Texas Medicaid/TMHP and PEMS experience
- Texas Medicaid managed care plan experience
- Medicare credentialing, PECOS enrollment, and revalidation experience
- Experience supporting an outpatient private practice
- Experience credentialing and enrolling mental health providers, including LPCs, LCSWs, psychologists, and other behavioral health clinicians
- Experience credentialing and enrolling allied health providers, particularly speech-language pathologists, occupational therapists, and physical therapists
- Availity experience
- EFT/ERA enrollment experience
- Medical billing or revenue cycle experience
Schedule & Compensation
- Part-time position, with hours expected to increase as Apex expands its clinical team, payer participation, and client base.
- Some weekday daytime availability is necessary for communication and follow-up with insurance payers.
What We Offer
- 100% remote work within Texas
- Flexible part-time schedule
- 90-day performance and compensation review
- Eligibility for a quarterly performance bonus
- Access to the Apex Thrive Program
- Opportunity for increased hours and expanded responsibilities as the practice grows
- Position is expected to grow into a full-time role as Apex's provider network, payer participation, and client volume expand
- Potential career growth into credentialing, medical billing, and revenue cycle operations
- Opportunity to help build and improve credentialing and payer enrollment systems within a growing therapist-owned practice
Who We're Looking For
The strongest candidate will understand the entire credentialing and payer enrollment process, rather than only one component of it. We are especially interested in someone who understands how credentialing and enrollment requirements differ across commercial insurance, Medicaid, Medicaid managed care, and Medicare, and who can help Apex maintain accurate payer participation information as our clinical team grows.
Experience primarily limited to medical billing, claims processing, insurance verification, prior authorizations, hospital privileging, HR/employee credentialing, license verification, or provider customer service does not by itself meet the experience requirements for this position. Experience supporting providers in outpatient behavioral/mental health and/or allied health settings is strongly preferred.
Apex Integrated Therapy Services, LLC is an Equal Opportunity Employer.
Pay: From $20.00 per hour
Benefits:
Application Question(s):
- Please describe your experience managing a provider from initial onboarding through payer participation. Include the steps you were responsible for.
- Please describe your experience managing payer participation across commercial insurance, Medicaid, and Medicare. Include any experience with Texas Medicaid/TMHP, PEMS, Medicaid managed care plans.
- Please describe the types of outpatient providers and practices you have supported. Include any experience with mental health providers or other allied health clinicians.
Work Location: Remote
