ABA Credentialing Specialist

About Behavioral Health Works

Behavioral Health Works is a growing organization focused on sustainable expansion by providing customized Applied Behavior Analysis (ABA) therapy to children and adolescents diagnosed with Autism Spectrum Disorder. Our team of expertly trained BCBAs, Case Supervisors, and Technicians partner closely with families to create individualized treatment plans that cater to each child's unique needs using principles grounded in Behavior Analysis.

Position Overview

We are seeking a meticulous and organized Credentialing Specialist to join our team remotely. This role involves managing provider credentialing, enrollments, and compliance activities throughout our multi-state operations. As a Credentialing Specialist, you will ensure providers are credentialed and enrolled efficiently to enable timely client service delivery while collaborating with clinical, operations, billing, and compliance teams.

Key Responsibilities

• Coordinate credentialing and re-credentialing processes for BCBAs and other clinical staff across multiple states.
• Prepare, submit, and monitor credentialing/enrollment applications with Medicaid, Medicare, and commercial payers.
• Maintain comprehensive records including licenses, certifications, and malpractice insurance documents for providers.
• Track application statuses and proactively engage with payers for updates.
• Ensure timely provider revalidations and renewals prior to deadlines.
• Update and manage provider profiles on platforms such as CAQH, NPPES, CMS I&A, and Availity.
• Conduct routine audits to maintain provider file accuracy and compliance with federal, state, and payer standards.
• Monitor expirations of provider credentials and verify exclusion lists (OIG, SAM), license sanctions, and Medicare/Medicaid opt-out statuses.
• Serve as the main contact for provider credentialing inquiries and assist with documentation completion.
• Communicate with insurance companies and payer agencies to resolve issues and discrepancies promptly.
• Maintain organized electronic credentialing documentation and support accreditation and audit preparations as needed.
• Compile reports detailing credentialing progress, enrollment status, and upcoming renewals.
• Identify and suggest process improvements for credentialing workflows.
• Support policy and SOP maintenance related to credentialing practices.

Qualifications

• Bachelor's degree in Healthcare Administration, Business Administration, Public Health, or equivalent experience preferred.
• At least two years of experience in provider credentialing or healthcare enrollment.
• Familiarity with Medicaid, Medicare, and commercial payer credentialing procedures.
• Proficient using credentialing platforms including CAQH, NPPES, CMS I&A, and Availity.
• Strong organizational ability and acute attention to detail.
• Excellent verbal and written communication skills.
• Competence in Google Workspace tools and Microsoft Office Suite, especially Excel and monday.com.

Preferred Experience

• Background in ABA, behavioral health, or outpatient healthcare environments.
• Experience with CentralReach or comparable practice management systems.
• Knowledge of provider credentialing across multiple states.
• Understanding of healthcare accreditation standards and compliance requirements.
• Familiarity with state-specific enrollment portals like California's PAVE and Massachusetts' EICS.

Employee Benefits

• Fully remote working environment.
• Starting competitive annual salary of $60,000.
• Comprehensive benefits including health, dental, vision, chiropractic, critical illness, voluntary life, accident, hospital confinement, and basic life insurance.
• 401(k) retirement plan.
• Pet insurance coverage.
• Paid time off and seven company-paid holidays yearly.
• Support for professional development and tuition discounts through university partnerships.
• Employee referral incentives and a collaborative workplace culture.