Credentialing Specialist

Behavioral Health Network
  • Springfield, Massachusetts
    4 days ago

    Job Description

    What We Offer: 

    • Purpose-Driven Work – Make a meaningful impact in the lives of individuals, families, and communities throughout Western Massachusetts.  
    • Professional Growth – Access ongoing training, mentorship, career development, and advancement opportunities across one of the region's largest behavioral health organizations.  
    • Supportive Team Culture – Join a collaborative workplace guided by our HEART values: Humanity, Empowerment, Accountability, Respect, and Teamwork.  
    • Stability & Opportunity – Build your career with a well-established organization serving Western Massachusetts since 1938.  
    • Comprehensive Benefits – Generous PTO, 403(b), educational assistance, medical, dental, vision, employee assistance programs, and more.  
    • Certified Great Place to Work – Work for an organization recognized for creating a positive and engaging employee experience. 

    What You Will Do: 

    • Processes individual provider initial credentialing applications, and biennial recredentialing applications.
    • Assists in onboarding clinical staff by verifying credentials, identity, degrees, certification, work history, etc.  
    • Monitors electronic credentialing workflow. Evaluates the quality of information provided by the CVO and escalates exceptions to the Clinical Director for review.
    • Ensures each individual credentialing application is processed by the credentialing committee for all initial and recredentialed clinical staff.
    • Monitors State Professional Licensure, Board Certification, DEA, CDS and other credentials as required. Reviews for pending expiration dates and follows up with staff to ensure their compliance.
    • Reviews CredentialStream alerts for State exclusions and professional licensing sanctions, OIG exclusions, SAM exclusions, Federal Sanctions, and notifies the Clinical Director of all identified concerns.
    • Maintains database of credentialed staff in CredentialStream, which includes staff credentials and insurance eligibility.
    • Prepares payer rosters and delegates credentialing oversite reports using the cadence defined by each insurance company.
    • Enrolls and empanels eligible clinical staff as determined by insurance contracts.

    Who You Are: 

    • High school diploma or GED required. 
    • Knowledge of insurance, clinical license levels and educational degrees, CPT coding, and guarantor credentialing standard required.
    • Familiarity with PECOS, NPI, CAQH, OIG exclusion list and Med Advantage required.
    • Insurance background with coding and billing required.

    PAY RANGE - $24.00 - $27.00 per hour - based upon experience 

    We Hire for HEART! 

    Since 1938, BHN has delivered high-quality, culturally responsive behavioral health care, building deep roots in Western Massachusetts while expanding our impact in communities throughout the state. Our core values—Humanity, Empowerment, Accountability, Respect, and Teamwork—guide how we lead, serve, and support one another. If you’re ready to bring your skills and experience to a mission-driven organization where your work can make a meaningful difference, we’d love to hear from you. 

     

    How do I apply?

    If you are interested in this opportunity, please click “Apply for Job” below or visit our website at www.bhnworks.org and click on “Browse All Jobs” to apply!  

     

    BHN is committed to social justice and diversity and strongly encourages diverse candidates to apply. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.

     

     

    Numbers & Facts

    LocationSpringfield, Massachusetts
    Websitehttps://www.bhninc.org/about

    Skills

    • Accreditation Standardsunmatched
    • Behavioral Healthunmatched
    • Billingunmatched
    • Cadenceunmatched
    • Clinical Competencyunmatched
    • Current Procedural Terminology (CPT)unmatched
    • Data Qualityunmatched
    • Database Administrationunmatched
    • Employee Assistance Planunmatched
    • High School Diplomaunmatched
    • Hospital/Healthcare Constructionunmatched
    • Insuranceunmatched
    • Maintain Complianceunmatched
    • Medical Assistanceunmatched
    • Mentoringunmatched
    • Product/Service Launchunmatched
    • Professional Licenseunmatched
    • Provider Credentialingunmatched
    • Team Playerunmatched
    • United States Drug Enforcement Agency (DEA)unmatched

    Be found by employers

    5,500+ employers search our resume database daily. Add yours to get found by recruiters looking for candidates like you.

    Level up your application

    Professional resume templates

    Browse dozens of recruiter approved resume templates, layouts and formats. Choose your favorite and make it your own in minutes.

    Free resume templates

    Resume Builder

    Improve your existing resume or start from scratch and create a standout, ATS-friendly resume. Add job-specific content, download and apply.

    Resume Builder