Credentialing Specialist/Support

Therapeutic Alliance LLC is a leading private mental health agency dedicated to providing culturally sensitive counseling services to diverse communities throughout Virginia. For over 13 years, we've been committed to addressing mental health, substance abuse, and behavioral issues using evidence-based methods and a supportive approach. We are a licensed provider of Intensive-In-Home (IIH), Mental Health Skill Building (MHSS), and Applied Behavioral Analysis (ABA) services.  Join our team and enjoy a rewarding career with excellent benefits : Health, Dental, and Vision Insurance Health Savings Account Life Insurance Performance Bonuses Unpaid Extended Leave Paid Time Off and Training Mileage and Travel Time Reimbursement Phone Reimbursement Flexible Schedule Liability Insurance Tuition Reimbursement RBT and QMHP Certification Support Staff Recognition Program Competitive Salary Structure Staff Referral Bonus Program The Credentialing and Support Specialist plays a vital role in ensuring smooth operations related to provider credentialing, contract management, insurance verification, and client cost-share management. Key Responsibilities : Credentialing Management :   Oversee the credentialing process for providers with Medicaid, commercial insurers, and other governmental agencies to ensure timely enrollment and active status.  Manage onboarding, credentialing, and registration for RBTs, QMHPs, and BCBAs, ensuring compliance with Medicaid and commercial insurance requirements.  Supervise company-wide credentialing efforts across all locations, ensuring timely completion and regulatory compliance.  Regularly review and update credentialing records for accuracy and ensure that all providers maintain active status.  Contracting Management :   Maintain up-to-date contract files, ensuring that all necessary documentation is accurate and easily accessible.  Oversee the contract process from initiation to completion, ensuring proper execution and adherence to terms.  Serve as a liaison with contracted agencies, addressing any concerns or questions and ensuring smooth communication between the parties.  Assist in audit preparation, providing requested documentation and keeping leadership informed of any changes that may impact operations.  Eligibility and Insurance Verification :   Verify client insurance coverage for accuracy, ensuring eligibility details are correct and up to date.  Educate clients on their insurance benefits, answering any questions related to coverage, co-pays, and other insurance-related matters.  Complete necessary documentation and relay any changes or issues with insurance eligibility to relevant teams, ensuring accurate billing and reporting.  Client Cost-Share Management :   Calculate and communicate cost-share estimates to clients based on their insurance coverage, ensuring transparency and understanding.  Obtain client consent for cost-share arrangements and manage payment schedules effectively.  Collaborate with the Billing Manager to ensure timely collections of cost-share payments, maintaining accurate records of all transactions.  Behavior Technician Responsibilities (Hybrid Role) :   Provide direct behavioral intervention services to clients in accordance with treatment plans under the supervision of a BCBA.  Implement behavior intervention plans (BIPs) and collect data on client progress under the supervision of a BCBA.  Collaborate with the clinical team to assess and adjust treatment plans as needed.      Qualifications :   Minimum 3 years of relevant experience  Comprehensive knowledge of behavioral health and managed care, particularly credentialing, contracting, and insurance verification with Medicaid and commercial insurers.  Strong understanding of managed care contracting and payer processes  Excellent communication skills (verbal and written)  Proficiency in Microsoft Office and Google Suite  Customer service orientation  Motivated, independent, and detail-oriented    Preferred :     Familiarity with Rethink and Availity systems.  Familiarity and experience working as a Behavior Technician in the field of Applied Behavior Analysis (ABA).     Ready to make a positive impact? Apply today and join our dedicated team at Therapeutic Alliance LLC!    CJ Powered by JazzHR