Demo

Credentialing Specialist

Children’s Specialized ABA
Kearny, NJ Full Time
POSTED ON 3/4/2025
AVAILABLE BEFORE 5/27/2025

Children’s Specialized ABA -

About Children's Specialized ABA

Children’s Specialized ABA is designed to address the comprehensive needs of children, teens, and young adults diagnosed with Autism Spectrum Disorder (ASD). By leveraging the expertise of the Children’s Specialized Hospital Autism Center of Excellence, the program aims to expand access to innovative and compassionate care, empowering children diagnosed with autism to thrive. Children’s Specialized ABA embraces a holistic approach, recognizing the interconnectedness of physical, emotional, and social well-being, ensuring every aspect of a patient’s life is considered in their therapeutic journey.

Our integrated care model brings ABA therapy services augmented by complementary therapies, such as speech and language, occupational, and behavioral health services, ensuring a comprehensive, whole-child approach that supports a wide range of needs, from verbal to behavioral and social skills.

The Values that set Children's Specialized ABA apart

  • Inclusivity : We celebrate the diversity within the Autism spectrum and are committed to creating an inclusive environment that respects and values each person’s individual strengths and differences.
  • Innovation : We foster a culture of creativity and collaboration, exploring new ideas to develop personalized solutions that enhance quality of life for all children with Autism.
  • Connection : We actively engage with the health systems and broader community to coordinate services and care for people with Autism.
  • Quality and Safety : We invest in research and training to provide cutting-edge, effective, safe and personalized services tailored to the unique needs of those we serve.

Summary :

The ABA Credentialing Specialist will manage the process of credentialing and re-credentialing providers in the field of Behavioral Health, ensuring compliance with state and insurance standards, regulatory requirements, and company policies. This role involves reviewing and maintaining certifications, working with insurance payors, and ensuring accurate documentation is kept for therapists, practitioners, and behavioral specialist.

This role can be 100 % remote or hybrid depending on the candidate's location. C andidates must live in one of the following states : NC, AZ, MD, NJ, IL, MO, TX, FL, or OH . Ideal candidates will have at least two years of experience in ABA credentialing.

Essential Job Functions / Job Duties & Responsibilities :

  • Manage the credentialing process for ABA professionals, ensuring compliance with state and federal regulations.
  • Verify and maintain credentials of licensed ABA therapists, board-certified behavior analysts (BCBAs), and other relevant practitioners.
  • Engage with employee providers and insurance payors to facilitate the credentialing process.
  • Review and process application documentation for initial credentialing and re-credentialing.
  • Ensure that credentialing documentation is accurate, up-to-date, and aligned with insurance and regulatory standards.
  • Update EHR system with approval and expiration dates.
  • Coordinate with ABA providers to gather necessary information for the credentialing process with persistent communication and ensure deadlines are met and expirations are renewed.
  • Respond to inquiries related to credentialing status and provide updates to both employee and insurance providers.
  • Stay current on regulatory changes, policies, and insurance requirements related to Medicaid guidelines and ABA credentialing.
  • Assist with profile and portal troubleshoot and advise ABA providers on credentialing processes and requirements.
  • Assist with audits related to ABA credentialing practices and inform of inactive, expired or credentialed employees to all relevant departments.
  • Minimum Qualifications :

  • High school diploma or equivalent (GED)
  • 2 years of authorizations, medical insurance, billing, or claims processing experience
  • Detail oriented, strong organizational, time management, analytical, problem solving, and customer service skills
  • Ability to multitask and track multiple items at the same time
  • Exceptional verbal, written, and interpersonal communication skills, including phone and email
  • Proficient in Microsoft Office, Google Sheets and Google Docs, with strong computer skills
  • Must pass background check upon hire
  • Children’s Specialized ABA provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.

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