Credentialing Specialist

Description

** This role is open to candidates in NJ, MD, AZ, or NC**

ABA Credentialing Specialist

Position Summary

Children’s Specialized ABA is seeking a detail-oriented and highly organized ABA Credentialing Specialist to support the credentialing and re-credentialing of providers across our organization.

The ABA Credentialing Specialist will manage credentialing processes for professionals within the Behavioral Health and ABA field, ensuring compliance with insurance payer requirements, state and federal regulations, and company policies. This position will work closely with providers, insurance payers, and internal departments to ensure credentialing documentation is accurate, complete, and processed in a timely manner.

The ideal candidate has experience with authorizations, medical insurance, billing, claims processing, or credentialing and is comfortable managing multiple priorities, communicating with providers and payers, and maintaining accurate documentation.

Reports To: Director of Payer Services

Essential Functions & Responsibilities

• Manage the credentialing and re-credentialing process for ABA professionals, ensuring compliance with applicable state, federal, insurance, and organizational requirements.
• Verify and maintain credentials for Board Certified Behavior Analysts (BCBAs), licensed ABA professionals, and other applicable practitioners.
• Communicate with providers and insurance payers throughout the credentialing process to obtain required information and resolve outstanding items.
• Review and process documentation for initial credentialing and re-credentialing applications.
• Ensure credentialing records are accurate, complete, current, and aligned with payer and regulatory requirements.
• Maintain approval dates, expiration dates, and other credentialing information within the EHR system.
• Proactively follow up with providers regarding missing documentation, upcoming expirations, renewals, and credentialing deadlines.
• Respond to credentialing inquiries and provide timely status updates to providers and internal stakeholders.
• Assist providers with credentialing profiles and payer portals, including troubleshooting issues and answering questions regarding requirements and processes.
• Stay current on Medicaid guidelines, payer requirements, regulatory changes, and policies impacting ABA credentialing.
• Support credentialing audits and communicate inactive, expired, pending, or fully credentialed provider statuses to appropriate departments.
• Maintain organized records and track multiple credentialing items simultaneously to ensure deadlines are met.

Qualifications

• High school diploma or equivalent (GED) required.
• 2+ years of experience in authorizations, medical insurance, billing, claims processing, credentialing, or a related healthcare administrative function.
• Experience working with insurance payers and/or healthcare provider documentation preferred.
• ABA or Behavioral Health experience preferred.
• Strong attention to detail with excellent organizational and time-management skills.
• Strong analytical, problem-solving, and customer service skills.
• Ability to multitask and effectively track multiple providers, applications, deadlines, and outstanding items simultaneously.
• Exceptional verbal, written, and interpersonal communication skills, including professional phone and email communication.
• Proficiency in Microsoft Office, Google Sheets, and Google Docs, with strong overall computer skills.
• Ability to learn and navigate EHR systems, insurance portals, and other credentialing platforms.

Physical Demands

The physical demands described below are representative of those required to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Visual and auditory ability to work on a computer and use a phone for extended periods of time.
• Ability to perform the physical requirements of the position for extended periods, including sitting, standing, bending, squatting, and kneeling.