Credentialing Specialist

We're building 'the' Teaching Hospital for pediatric therapy – a category of one by driving excellence in outcomes, developing clinicians, building payer trust, and embedding systems across what we do. As a member of the Revenue Cycle Management Team, the Credentialing & Billing Specialist supports two critical functions that directly impact timely reimbursement and access to care: billing and provider credentialing. This role combines hands‑on healthcare billing responsibilities with a strong focus on credentialing application preparation, submission, tracking, and payer follow‑up. The ideal candidate is highly organized, detail-oriented, persistent, and comfortable managing multiple payer requirements and deadlines at the same time. Success in this role means claims are submitted accurately and timely, credentialing applications move forward without unnecessary delays, and payer issues are actively followed through to resolution. Your work helps prevent billing delays and denials, expands provider capacity, supports cash flow, and ensures families can access services as quickly as possible. Key Responsibilities Billing Prepare, review, and submit claims accurately in compliance with payer requirements, coding standards, and internal policies. Ensure services are billed within established timelines, targeting an average of five days from the date of service. Monitor daily billing queues and prioritize work to ensure timely claim submission. Re-bill claims promptly when notified of insurance, authorization, credentialing, or other changes. Monitor clearinghouse rejections, research errors, make necessary corrections, and resubmit claims promptly. Identify billing issues related to provider enrollment or credentialing and collaborate with the appropriate RCM team members to resolve them. Maintain accurate documentation of billing activity and outstanding issues. Credentialing & Payer Enrollment Prepare and submit new provider credentialing, enrollment, and re-credentialing applications to commercial and government payers. Gather and verify all documentation required for payer applications to ensure submissions are complete and accurate. Maintain provider demographic and credentialing information, including CAQH profiles, NPI information, licenses, certifications, and other required records. Actively track applications from submission through completion, following up consistently with payers until enrollment is finalized. Contact payers by phone, portal, email, or other available channels to obtain application status, identify missing information, resolve outstanding requirements, and move applications forward. Document payer contacts, reference numbers, application status, next steps, and required follow‑up dates. Respond promptly to payer requests for additional information or documentation. Identify applications that are stalled or exceeding expected turnaround times and elevate appropriately. Monitor credentialing and re-credentialing deadlines to prevent lapses in provider participation. Assist with payer rosters and provider directory information to ensure approved providers are accurately reflected. Communicate clearly with providers and internal teams when additional information is needed or when credentialing status changes. Maintain organized, accurate, and audit‑ready credentialing records. Shared Responsibilities Manage a high‑volume workload while maintaining accuracy, organization, and appropriate follow‑up. Maintain clear documentation so the current status and next action for billing and credentialing items can be easily identified. Collaborate with Credentialing, Contracting, Eligibility, Authorization, Billing, and AR teams to prevent front‑end issues from becoming claim delays or denials. Recognize recurring payer or process issues and elevate trends that may require broader resolution. Uphold HIPAA, confidentiality, payer, and regulatory requirements in all work. Contribute to process improvement initiatives across the revenue cycle. Performance Metrics Average Days to Bill: 5 days or fewer, with 75% of services billed within the same month. First Pass Acceptance Rate: =90% clean claim acceptance. Credentialing Application Accuracy: =95% of applications accepted without avoidable corrections or missing information. Credentialing Follow‑Up: 100% of active applications followed up according to established payer‑specific or departmental timelines. Credentialing Turnaround: Applications completed within established payer and organizational expectations, with delays proactively identified and escalated. Documentation: Accurate and current status, follow‑up, and next‑action documentation maintained for assigned credentialing applications. Error Prevention: Active identification and resolution of billing and credentialing issues that could delay claims or provider readiness. Requirements Desired Qualifications and Experience High school diploma required; Associate's or Bachelor's degree in healthcare administration, business, or related field preferred. Minimum 2 years of healthcare revenue cycle experience with demonstrated experience in provider credentialing, payer enrollment, billing, or a combination of these functions. Hands‑on experience completing and submitting provider credentialing or payer enrollment applications strongly preferred. Demonstrated experience following up directly with insurance payers on pending applications, enrollment status, missing information, and processing delays. Knowledge of credentialing and payer enrollment processes, including CAQH, NPI registration, provider demographics, and payer‑specific requirements. Familiarity with healthcare billing requirements, CPT/HCPCS codes, modifiers, clearinghouse rejections, and claim submission processes. Strong organizational and follow‑up skills with the ability to manage multiple applications, claims, deadlines, and payer requirements simultaneously. High attention to detail and accuracy in application preparation, data entry, and documentation. Persistence and comfort communicating directly with insurance payers to move outstanding items toward resolution. Strong problem‑solving skills and ability to independently research and resolve routine payer issues. Clear written and verbal communication skills for interacting with providers, payers, and internal teams. Experience with credentialing databases, RCM/EHR systems, and Microsoft Office Suite; CentralReach experience highly preferred. Commitment to confidentiality, compliance, and HIPAA standards. Basic & Physical Requirements Must have manual dexterity to perform specific computer and electronic device functions. Must have visual acuity to read and comprehend written communication through computers, electronic devices, and paper means. Must be able to maintain prolonged periods of working on a computer while sitting at a desk and attending virtual meetings. Job Type: Non-Exempt, Full-Time Pay is competitive and based on candidate qualifications and experience. Full‑time employees will be offered our comprehensive benefits including Paid Time Off, 401k, insurance (health, dental, and vision), and the option of Short‑and‑Long‑Term Disability insurance. Our Story: A Legacy of Progress, Fueled by Play In 2006, Bierman Autism Centers began with a simple dream: to empower children with autism to thrive. We believed in the power of letting kids be kids and initially offered in‑home care to foster a comforting and familiar environment. We were driven by three core beliefs: achieving remarkable progress with children, creating a great team that enjoys working together, and building a workplace that fosters internal career paths and growth for our team members. Our dedication to progress led us to a pivotal moment. Recognizing the potential of center‑based care, we opened our first center in Indiana in 2010. This wasn’t just about location; it shifted our philosophy. Centers allowed us to create consistent, nurturing environments tailored to each child’s needs. This shift became the cornerstone of our success. Today, Bierman Autism Centers are beacons of innovative care across Arizona, Indiana, Massachusetts, New Jersey, North Carolina, Ohio, and Rhode Island. We offer ABA therapy, Speech Therapy, Occupational Therapy and Diagnostic Services within center‑based settings designed for the comprehensive development of our children. Bierman Autism Centers values diversity in the workplace. The company provides equal opportunity for employment and promotion to all qualified employees and applicants on the basis of experience, training, education, and ability to do the available work without regard to race, religion, color, age, sex/gender, sexual orientation, national origin, gender identity, disability, marital status, veteran status, genetic information, ancestry, or any other status protected by law. Furthermore, Bierman Autism Centers is committed to providing an equal opportunity workplace that is free of discrimination and harassment based on national origin, race, color, religion, gender, ancestry, age, sexual orientation, gender identity, disability, marital status, veteran status, genetic information, or any other status protected by law. As an equal opportunity employer, Bierman Autism Centers does not discriminate against qualified individuals with disabilities. If you require a reasonable accommodation as a candidate for employment, please inform a member of the Talent Acquisition team. #J-18808-Ljbffr