Credentialing Specialist

Position : Credentialing Specialist

Industry : Applied Behavior Analysis (ABA)

Employment Type : Full-Time

Gender : Open to all candidates

Location : Remote / On-site (specify based on your setup)

Overview

We are looking for a highly skilled and detail-oriented Credentialing Specialist to join our team. The ideal candidate has exceptional organizational abilities, strong communication skills, and proven experience managing credentialing processes in healthcare or ABA settings. This role is critical in ensuring our clinicians maintain accurate, up-to-date credentials and compliance with payer, licensing, and regulatory requirements.

Key Responsibilities

• Manage the full credentialing and re-credentialing process for ABA providers with insurance companies, licensing boards, and regulatory agencies.
• Prepare, complete, and submit credentialing applications and documentation accurately and on time.
• Track provider credentialing status, expirations, renewals, and compliance requirements using internal systems.
• Maintain organized and up-to-date digital records of all provider credentials and documents.
• Communicate professionally with clinicians, insurance representatives, and internal departments regarding application status or missing requirements.
• Resolve credentialing issues or delays efficiently to ensure uninterrupted billing and service delivery.
• Verify provider qualifications, education, background checks, and certifications.
• Ensure compliance with state regulations, HIPAA, and payer-specific standards.
• Work cross-functionally with HR, Billing, and Clinical teams as needed.
• Assist in system improvements, workflow development, and process documentation for credentialing operations.

Requirements