Job Description

Job Description

Job Description

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.

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.

• 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).

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

Applied Behavior Center for Autism is an Equal Opportunity Employer and fully subscribes to the principles of Equal Employment Opportunity. The company ensures that all applicants and employees are considered for hire, promotion, and job status, without regard to race, color, religion, gender, national origin, age, veteran status, disability, or any other characteristic protected by law.

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