Credentialing Specialist

Job Description

Job Description

Description:

Three Rivers Therapy is seeking an experienced Credentialing & Provider Contracting Specialist to support our growing behavioral health organization. This is a part-time, in-person role for someone who brings deep expertise in provider credentialing, insurance contracting, payer enrollment, and multi-state provider licensing.

We are looking for someone who has operated at a high level in healthcare credentialing and understands the full provider lifecycle, from licensing and payer enrollment to payer contracting and billing readiness. This role will be instrumental in supporting provider growth, strengthening payer relationships, and ensuring operational and financial continuity across the organization.

Position Summary

The Credentialing & Provider Contracting Specialist will oversee provider credentialing, recredentialing, payer enrollment, licensing, and insurance contracting efforts for Three Rivers Therapy. This role requires someone who understands the strategic side of credentialing, not just application processing.

The ideal candidate has strong experience navigating payer contracts, provider enrollment requirements, behavioral health reimbursement structures, and multi-state credentialing compliance.

Key Responsibilities

Provider Credentialing & Enrollment
• Manage full-cycle provider credentialing and recredentialing for licensed behavioral health providers
• Complete primary source verification for licenses, certifications, education, training, and employment history
• Prepare, submit, and manage payer enrollment applications for commercial insurance, Medicaid, Medicare, and other contracted payers
• Monitor credentialing timelines and proactively resolve delays that could impact provider onboarding or billing readiness
• Track provider expiration dates and ensure timely renewal of licenses, certifications, and registrations
• Support provider licensing efforts in current and future expansion markets

Insurance Contracting & Payer Relations
• Manage payer contracting processes, including contract applications, negotiations, follow-up, and implementation
• Review reimbursement structures and identify opportunities for contract optimization where appropriate
• Serve as a point of contact for payer communications related to provider enrollment, participation status, and contract matters
• Maintain awareness of payer requirements, credentialing standards, and contract renewal timelines
• Assist leadership with strategic expansion planning related to payer access and network participation

Compliance & Quality Assurance
• Maintain credentialing and contracting files in accordance with CMS, HIPAA, payer, and state-specific regulations
• Ensure provider records remain complete, accurate, and audit-ready
• Support internal and external audits related to provider credentialing and payer compliance
• Identify process improvements to strengthen credentialing workflows and reduce operational bottlenecks
• Maintain strict confidentiality and professionalism in all interactions

Collaboration & Organizational Support
• Partner with leadership, operations, finance, credentialing, and clinical teams to ensure provider readiness
• Provide regular status updates regarding credentialing progress, contracting timelines, and barriers
• Support growth initiatives involving new providers, new service lines, and expansion into additional markets
• Assist with related special projects as needed

Requirements:

Required
• Bachelor’s degree in business, healthcare administration, or related field
• Minimum 5+ years of progressive healthcare credentialing experience
• Demonstrated experience with insurance payer contracting and provider enrollment
• Strong knowledge of behavioral health credentialing and reimbursement structures preferred
• Proven experience managing multi-state provider licensing and credentialing
• In-depth knowledge of CMS, HIPAA, commercial payer requirements, and state credentialing regulations
• Strong experience working with Medicare, Medicaid, and commercial insurance plans
• Excellent organizational skills with strong follow-through and attention to detail
• Ability to work independently with minimal oversight
• Strong written and verbal communication skills

Preferred
• Behavioral health credentialing experience
• Experience supporting multi-location healthcare organizations
• Experience with provider expansion strategy and payer network development