Credentialing Specialist

Credentialing Specialist

Reports To: CFO

Shift: Flexible, hybrid work schedule.

Status: Exempt

Job Title: Credentialing Specialist

About Applied Behavior Center for Autism:

At the Applied Behavior Center for Autism, our mission is to provide individualized, evidence-based services to children with Autism Spectrum Disorder (ASD) and their families.

Position Overview:
We are seeking an experienced Credentialing Specialist to oversee the provider enrollment, credentialing, and re-credentialing processes for our clinicians and facilities. This role ensures that all facilities, clinicians, and practitioners meet and maintain the necessary qualifications for participation in insurance networks, with a focus on Medicaid and a multi-payer system. This position is hybrid, allowing for a mix of in-office and remote work.

Key Responsibilities:

• Credentialing & Recredentialing:

• Initiate and manage the credentialing and recredentialing process for all providers and facilities, ensuring compliance with payer, state and federal regulations.
• Prepare and submit credentialing applications to insurance companies, Medicaid, and MCOs, ensuring timely approvals.
• Maintain accurate records of all credentialing and recredentialing activities, tracking expiration dates and compliance requirements.
• Provider Network Management:
  • Collaborate with insurance companies to ensure providers are successfully enrolled and in-network, resolving eligibility issues as needed.
  • Serve as the primary point of contact for credentialing inquiries from payers, government entities, and internal teams.
  • Stay informed of payer policies and procedures to maintain compliance.
• Medicaid & Payer System Expertise:
  • Possess extensive knowledge of Medicaid, commercial insurance, and other payer credentialing requirements.
  • Ensure accurate and timely completion of Medicaid and payer enrollment forms.
  • Monitor and adapt to changes in payer requirements, Medicaid expansion, regulatory updates and other legislative changes.
• Documentation & Compliance:
  • Verify and maintain provider and facility credentials, including licenses, certifications, insurance, and background checks.
  • Ensure all required documentation is submitted and maintained for credentialing and recredentialing in a timely manner.
  • Track and manage expiring certifications and licenses, ensuring timely renewals.
  • Conduct periodic audits to ensure regulatory and payer compliance.
• Internal Collaboration & Reporting:
  • Work closely with HR and Operations to facilitate efficient provider onboarding.
  • Prepare and submit credentialing status reports to management.
  • Assist in training staff on credentialing policies and procedures.
• Process Improvement & Industry Best Practices:
  • Recommend and implement workflow improvements to enhance efficiency and accuracy.

  • Stay current with industry best practices and regulatory changes.

Required Qualifications:

• Minimum of 5 years of experience in credentialing, preferably within a multi-location or behavioral health setting.
• Extensive knowledge of Medicaid, commercial insurance, and payer credentialing processes.
• Proficiency in Microsoft Office Suite (Word, Excel, Outlook) and credentialing software systems (e.g., CAQH, Verisys, or others).

Preferred Qualifications:

• Bachelor’s degree in healthcare administration, business, or a related field.
• Certification in credentialing (CPCS, CPMSM, or HCR) is a plus but not required.
• Excellent communication and interpersonal skills to interact with insurance companies, providers, and internal teams.
• Detail-oriented with exceptional organizational and time management skills to manage multiple tasks and deadlines.
• Ability to handle sensitive and confidential information with discretion.
• Self-motivated and able to work independently in a hybrid work environment.

Compensation:
Pay Range: Competitive salary and benefits package commensurate with experience.

Benefits:

• 3.5% match 401k plan

• PTO & paid holidays

• Full health, dental, and vision insurance

Work Environment:

• Flexible, hybrid work schedule.

If you are passionate about working with children and making a significant impact in the lives of families affected by autism, we encourage you to apply for this rewarding position as a Credentialing Specialist at our Applied Behavior Center for Autism

If you are passionate about working with children and making a significant impact in the lives of families affected by autism, we encourage you to apply for this rewarding position as a Registered Behavior Technician at our Applied Behavior Center for Autism