ABA Director – Credentialing

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

📋 Description

• Manage comprehensive provider credentialing and recredentialing processes across four organizations in ten states.

• Direct provider enrollment, revalidation, and ongoing maintenance tasks with Medicaid, Managed Care Organizations, Regional Centers, Medicare, and commercial payers.

• Ensure that provider records, licenses, certifications, and credentialing documentation are up-to-date and compliant.

• Create and uphold credentialing performance metrics and service-level standards.

• Guarantee adherence to federal, state, regional, payer, and accreditation regulations.

• Perform internal compliance audits and establish corrective action plans.

• Develop, implement, and sustain production and quality standards for the compliance program.

• Supervise the monitoring of SAM, OIG exclusions, state license sanctions/exclusions, Open Payments, and Medicare/Medicaid Opt-Out statuses.

• Act as a subject matter expert on credentialing, enrollment, and provider compliance regulations.

• Spearhead contracting and enrollment initiatives with Medicaid agencies, Managed Care Organizations, Regional Centers, and commercial payers.

• Assist in payer negotiations, contract implementation, and the expansion of provider networks.

• Cultivate and maintain relationships with payers, regulatory agencies, and internal stakeholders.

• Oversee policy lifecycle and governance processes.

• Establish and uphold organizational SOPs, policies, and procedures.

• Promote standardization and process improvement across credentialing and compliance functions.

• Lead accreditation activities, including preparation, implementation, and ongoing compliance with ACQ standards.

• Ensure readiness for audits and regulatory compliance.

• Mentor and develop team members in credentialing, enrollment, and compliance.

• Set departmental goals, performance standards, and quality benchmarks.

• Design and deliver employee training programs.

• Encourage accountability, collaboration, and ongoing improvement.

⛳️ Requirements

• A Bachelor's degree in Healthcare Administration, Business Administration, Public Health, or a related field; a Master's degree is preferred.

• Experience in ABA, behavioral health, or healthcare services organizations.

• Proficient in credentialing and provider enrollment platforms, including CAQH, NPPES, CMS I&A, Availity, Salesforce, CentralReach, provider enrollment systems, content management systems (CMS), and Microsoft Office Suite (advanced Excel preferred).

• At least 7 years of experience in provider credentialing, healthcare compliance, provider enrollment, or payer contracting.

• Proven track record in multi-state provider credentialing and payer enrollment operations.

• Extensive knowledge of Medicaid, Medicare, commercial payer credentialing, and managed care requirements.

🏝️ Benefits

• Flexible remote work environment

• Competitive salary and performance-based incentives

• Comprehensive benefits package

• Opportunities for professional development and career growth

• Collaborative and supportive work culture

• Leadership development opportunities

• Health, Dental, Chiropractic, and Vision Insurance

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

• 401(k)

• Pet Insurance

• Paid Time Off

• 9 Company-Paid Holidays per year, including 6 fixed holidays and 3 floating holidays

• Professional Development Assistance

• Employee Referral Program

• Tuition Reduction Programs through affiliated university partners