ABA Credentialing Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Oversee the credentialing and re-credentialing processes for BCBAs and other clinical providers across various states.

• Prepare, submit, and monitor applications for credentialing and enrollment with Medicaid, Medicare, and commercial insurance payers.

• Maintain comprehensive provider records, including licenses, certifications, malpractice insurance, and all credentialing documentation.

• Track the progress of credentialing applications and proactively engage with payers regarding their status.

• Ensure timely completion of provider revalidations and re-credentialing renewals before established deadlines.

• Keep provider profiles updated in CAQH, NPPES, CMS I&A, Availity, and other credentialing systems.

• Guarantee that provider files are complete, accurate, and compliant with federal, state, and payer regulations.

• Monitor expiration dates for provider licenses, certifications, and credentials.

• Conduct regular audits of provider files and credentialing records.

• Assist in tracking OIG exclusions, SAM, state license sanctions, and Medicare/Medicaid Opt-Out status.

• Organize and maintain electronic credentialing files and documentation systematically.

• Act as the primary contact for providers regarding inquiries related to credentialing and enrollment.

• Liaise with insurance companies, Medicaid agencies, and commercial payers about application statuses and necessary documentation.

• Aid providers in completing credentialing paperwork and securing required documents.

• Address credentialing issues and enrollment discrepancies in a timely manner.

• Utilize spreadsheets and internal systems to monitor credentialing and enrollment statuses.

• Generate reports detailing credentialing activities, enrollment statuses, and upcoming renewals.

• Identify and implement improvements to enhance credentialing workflows and operational efficiency.

• Assist in maintaining standard operating procedures, policies, and credentialing documentation.

• Support accreditation and audit preparations as assigned.

⛳️ Requirements

• Bachelor’s degree in Healthcare Administration, Business Administration, Public Health, or a related discipline preferred, or equivalent work experience.

• At least 2 years of experience in provider credentialing or healthcare enrollment.

• Familiarity with Medicaid, Medicare, and commercial payer credentialing processes.

• Experience with CAQH, NPPES, CMS I&A, Availity, or other similar credentialing platforms.

• Solid understanding of provider credentialing and payer enrollment procedures.

• Exceptional organizational abilities and attention to detail.

• Strong communication skills, both written and verbal.

• Proficient in Google Workspace (Drive, Sheets, Forms) and Microsoft Office, particularly Excel, monday.com.

🏝️ Benefits

• Fully remote work environment.

• Competitive salary starting at $60,000 annually.

• Comprehensive benefits package.

• Opportunities for professional development and career advancement.

• Supportive and collaborative workplace culture.

• Health, Dental, Chiropractic, and Vision Insurance.

• Coverage for Critical Illness, Voluntary Life, Accident, Hospital Confinement, and Basic Life Insurance.

• 401(k) plan.

• Pet Insurance available.

• Paid Time Off.

• 7 Company-Paid Holidays each year.

• Assistance with professional development.

• Employee Referral Program.

• Tuition reduction programs through affiliated university partners.