Credentialing Specialist

Credentialing Specialist

Claratel Behavioral Health is seeking a dedicated and experienced Credentialing Specialist. This role is responsible for managing provider credentialing, payer enrollment, and maintaining payer relationships. The Credentialing Specialist serves as the primary liaison between the agency and payer therefore, playing a key role in optimizing revenue cycle performance.

Key Responsibilities:

• Build and maintain strong relationships with Medicaid, Medicaid CMOs, and Commercial Payers
• Serve as the primary point of contact for payer communications, issue resolution, and escalations
• Attend Medicaid, CMO, and payer sponsored meetings and trainings
• Manage end-to-end provider credentialing and recredentialing processes
• Complete, track, and monitor payer enrollment applications for new payer contracts
• Maintain accurate and up-to-date provider data
• Maintain provider profiles in CAQH database
• Enroll and manage staff access in payer portals including:
• GAMMIS
• Availity
• Palmetto GBA Portal
• Ensure timely completion of attestations and revalidations
• Monitor provider licensure, certifications, and renewals to ensure ongoing compliance
• Track and verify sanctions, exclusions, and disciplinary actions (OIG, SAM, State Boards)
• Monitor associate-level staff working toward full licensure and ensure proper payer alignment
• Maintain all required credentialing documentation
• Collaborate with HR and Clinical Leadership to support provider onboarding
• Ensure data integrity and consistency across EHR, payer systems, and credentialing platforms
• Provide regular status updates and timelines for leadership
• Track and report on key credentialing and enrollment metrics (turnaround time, enrollment lag, recredentialing compliance)

Skills and Competencies:

• In-depth knowledge of credentialing, payer enrollment, and regulatory requirements
• Proficient in CAQH maintenance and management
• Intermediate proficiency in Excel
• Strong analytical and problem-solving skills
• Ability to develop strong collaborative working relationships with internal partners
• Ability to manage multiple priorities simultaneously with strict and competing deadlines
• Ability to adapt quickly to changing priorities
• Highly self-motivated with strong organizational skills and attention to detail
• Exercise sound judgement, including appropriate escalation of issues when necessary
• Excellent interpersonal skills including the ability to interact effectively and professionally with individuals at all levels; both internal and external
• Embraces and leverages technology to enhance efficiency
• Must possess strong ethics and a high level of personal and professional integrity

Preferred Experience:

• Minimum 2-3 years of credentialing experience in a multi-provider environment required
• Preferred but not required: CPCS- Certified Provider Credentialing Specialist

Pre-employment drug screening and successful completion of a criminal history background check is required.

Claratel Behavioral Health participates in E-Verify (Company ID: 226305)

Claratel Behavioral Health is an Equal Opportunity Employer. Candidates who may require an accommodation under the Americans with Disabilities Act or similar law to perform the essential functions of this job are encouraged to contact Human Resources at View email address on click.appcast.io.