Credentialing Specialist

• Facilitate end-to-end credentialing and enrollment processes for ABA providers with contracted health plans, ensuring timely and compliant submissions.
• Process and track initial credentialing and re-credentialing (reappointments) applications for clinicians across multiple insurance networks.
• Maintain accurate, up-to-date provider credentialing files, including but not limited to licenses (e.g., LBA), certifications (e.g., BCBA, RBT), and supporting documentation.
• Manage and update provider profiles in credentialing databases such as CAQH (Council for Affordable Quality Healthcare) to ensure data accuracy and completeness.
• Monitor credentialing statuses, proactively follow up on outstanding items, and ensure deadlines and payer requirements are met.
• Respond to internal and external requests for credentialing information, documentation, and status updates in a timely and professional manner.
• Coordinate cross-functionally with Recruitment, HR, Onboarding, Compliance, and Hiring Managers to communicate credentialing requirements, timelines, and status updates.
• Liaise with external vendors, payors, and regulatory agencies to facilitate credentialing, resolve issues, and ensure compliance with all applicable standards.
• Maintain strong attention to detail while managing multiple credentialing workflows, ensuring data integrity across systems and trackers.
• Support audits and compliance reviews by ensuring all credentialing documentation is complete, accurate, and readily accessible.
• Assist in developing, updating, and improving credentialing processes, SOPs, and tracking mechanisms.
• Provide administrative support across all aspects of credentialing operations.
• Any other duties as assigned

Qualifications and Skills:

• Bachelor's Degree preferred, but not necessary
• At least one year of Credentialing/Data Entry Experience
• Experience working with insurance networks, healthcare credentialing, or ABA providers preferred
• Excellent organizational skills with a strong ability to multi-task and navigate multiple systems simultaneously in a fast-paced environment.
• Proficiency in self-managing time and priorities
• Excellent customer service, must have exceptional communication skills over the phone and via email
• Exceptional attention to detail
• A professional, yet friendly demeanor
• Knowledge of Microsoft Office applications (e.g. Word, Excel, Outlook, Teams)
• Proficiency in data management and systems (e.g., CAQH, internal HRIS/credentialing trackers)