Credentialing Specialist

Credentialing Specialist

Job Title: Credentialing Specialist


Location: Naples, Florida

Company : David Lawrence Centers for Behavioral Health

Job Type: Full-Time Hourly/Non-exempt

Schedule: Hybrid role - Monday-Thursday, 8:00am - 5:00pm and Friday, 8:00am - 3:00pm

Hiring Incentives : Offering immediate PTO accrual, comprehensive medical/dental/vision benefits, 401(k) with employer match, and professional development/tuition assistance.

Job Summary:

The Credentialing Specialist is responsible for managing the full lifecycle of provider, organizational, and location credentialing for behavioral health and psychiatric hospital staff. This role ensures compliance with federal, state, and payer regulations, maintains credentialing systems and registries, submits provider rosters to payers, and manages provider terminations as required. This position is critical to maintaining uninterrupted provider coverage, payer participation, and timely reimbursement for behavioral health services.

Key Responsibilities:

• Manage initial credentialing, re-credentialing, and privileging of behavioral health providers, including psychiatrists, therapists, TCM, and advanced practitioners.
• Collect, verify, and maintain provider documentation, including licenses, certifications, DEA numbers, education, work history, malpractice history, and references.
• Coordinate provider enrollment and ongoing maintenance with payers.
• Request, track, and maintain provider identifiers and enrollment data, including Medicare/Medicaid, NPI numbers, and taxonomy codes, ensuring accuracy across payer portals, credentialing systems, and internal records.
• Maintain organizational and location credentialing for the psychiatric hospital and affiliated sites, ensuring all licenses, certifications, and regulatory requirements are current.
• Maintain and update credentialing systems, registries, and internal tracking tools (e.g., CAQH, NPPES, master credentialing spreadsheet) to ensure accurate provider records, monitor expirations, and track credentialing and payer enrollment status.
• Submit provider rosters and updates to payers as required for enrollment, re-credentialing, network participation, and terminations.
• Provide ongoing status updates to clinical programs and operational teams regarding provider credentialing and payer enrollment progress and formally communicate when providers are fully approved and authorized to begin delivering services to payer members.
• Initiate and process provider terminations in credentialing and enrollment systems and notify payers in accordance with regulatory and contractual requirements.
• Monitor compliance with federal and state regulations, CMS requirements, and payer credentialing and enrollment policies.
• Prepare reports on credentialing status, compliance metrics, and provider enrollment activities.
• Serve as a primary point of contact for providers, payers, and internal departments regarding credentialing and enrollment matters.
• Collaborate with Human Resources, Compliance & Risk Management, Revenue Cycle, and Operations teams to support onboarding, ongoing compliance, and continuity of services.
• Communicate credentialing requirements and updates to providers and leadership as needed.

Qualifications:

• High School Diploma/GED; associate or bachelor's degree in healthcare administration, business, or related field preferred.
• Minimum of 2-3 years of experience in credentialing and provider enrollment, preferably in behavioral health or psychiatric hospital setting.
• Strong knowledge of behavioral health licensure requirements, Medicare and Medicaid enrollment processes, CMS regulations, and payer credentialing standards.
• Experience working with credentialing and enrollment systems and registries (e.g., CAQH, NPPES, payer portals).
• Familiarity with risk management, privileging processes, and compliance audits
• Exceptional skills in organization (time and information), task prioritization and independent problem solving.
• Seamless ability to switch between tasks of all levels and sizes.
• Ability to relate to and communicate with a diverse group of clients and colleagues
• Microsoft Office 365 skills (Including Teams/Video Conferencing) and Electronic Medical Records experience = Strongly Preferred
• Staying compliant on all training and immunizations.
• Ability to pass Level II DCF Mental Health Fingerprinting (General Information can be found HERE ) , Drug Screen and Local Criminal Check

Physical Requirements:


This position requires a mix of physical activities throughout the workday. Duties involve periods of standing, sitting, and walking, often across various areas of the site. The role also includes tasks that may require bending, reaching, and other physical movements. Candidates must be able to occasionally lift and carry items weighing up to 50 pounds. A reasonable level of physical stamina and mobility is necessary to successfully perform the essential functions of this role.