- Coordinate provider credentialing and re-credentialing for BCBAs and clinical staff across multiple states.
- Prepare, submit, and track credentialing and enrollment applications with Medicaid, Medicare, and commercial payers.
- Maintain accurate provider records, including licenses, certifications, and malpractice insurance documentation.
- Monitor provider file compliance, perform routine audits, and track OIG/SAM exclusions or license sanctions.
- Serve as the point of contact for providers and payers regarding credentialing status, discrepancies, and documentation.
- Utilize credentialing platforms like CAQH, NPPES, and CMS I&A to maintain provider profiles.
- Prepare reports on credentialing activities and identify opportunities to improve operational workflows.
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