ABA Credentialing Specialist
New
B
Behavioral Health WorksHealthcare
United StatesFull-TimeMiddle
SalaryAt least 60,000 USD per year
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Job Details
- Experience
- Minimum of 2 years of provider credentialing or healthcare enrollment experience.
- Required Skills
- Microsoft ExcelGoogle Workspace
Requirements
- Minimum of 2 years of professional provider credentialing or healthcare enrollment experience.
- Experience managing credentialing applications with Medicaid, Medicare, and commercial insurance payers.
- Proficiency with credentialing platforms such as CAQH, NPPES, CMS I&A, and Availity.
- Strong proficiency in Google Workspace (Drive, Sheets, Forms) and Microsoft Office, specifically Excel.
- Demonstrated experience using project management or collaboration tools like monday.com.
- Excellent organizational skills and high attention to detail for audit and compliance tasks.
- Strong written and verbal communication skills for frequent interaction with payers and providers.
- Bachelor's degree in Healthcare Administration, Business Administration, Public Health, or a related field (preferred).
- Experience in ABA, behavioral health, or outpatient healthcare (preferred).
- Experience with CentralReach or similar practice management software (preferred).
- Familiarity with state-specific provider enrollment portals (e.g., PAVE, EICS) (preferred).
Responsibilities
- 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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