Credentialing Manager (ABA Healthcare)

Fiesta Health LLC; India; Remote; INR 1.200.000 - 1.800.000; Vollzeit

Benefits dieser Stelle

Remote work

Flexible schedule

Zusammenfassung

Fiesta Health LLC is seeking a seasoned Credentialing Manager for remote work from India to oversee provider credentialing, payer enrollment, and contract management for U.S. payers.

The role requires extensive experience credentialing BCBAs, psychologists, physicians, and ABA clinics with Medicaid and commercial insurers. The candidate will manage CAQH, enrollments, provider rosters, and payer relationships, coordinating with insurers to resolve delays and ensure in-network status.

Qualifikationen

• Minimum 5 years of U.S. healthcare credentialing experience.
• Minimum 3 years of ABA credentialing experience.
• Extensive credentialing with BCBAs, psychologists, physicians, and ABA clinics.
• Experience with Medicaid and commercial insurers.
• Experience calling insurance companies to resolve credentialing issues.
• Excellent spoken and written English.

Aufgaben

• Complete initial credentialing for BCBAs and other providers.
• Manage provider recredentialing and demographic updates.
• Submit provider additions and terminations; maintain records.

Kenntnisse

Credentialing

Negotiation

English Proficiency

Organization

Multitasking

Tools

CAQH

Availity

Excel

Provider portals

Monday.com

Jobbeschreibung

Location: Remote (India) Job Type: Independent Contractor Work Schedule: Monday–Friday | U.S. Business Hours

About Fiesta Health

Fiesta Health is a rapidly growing ABA provider serving children with autism throughout Georgia. As we continue to expand, we are seeking an experienced Credentialing Manager to oversee all aspects of provider credentialing, payer enrollment, contract management, and payer relationship management. This is not an entry-level credentialing position. We are looking for someone with extensive experience credentialing BCBAs and ABA providers with Medicaid and commercial insurance companies in the United States. The ideal candidate is comfortable communicating directly with insurance companies, resolving enrollment issues, negotiating contracts, and ensuring providers remain credentialed and in-network.

Position Overview

• Initial credentialing
• Recredentialing
• Medicaid enrollments
• Commercial payer enrollments
• CAQH management
• Contract negotiations
• Rate negotiations
• Payer issue resolution
• Provider roster maintenance
• Ongoing payer relationship management

Key Responsibilities

Provider Credentialing

• Complete initial credentialing for BCBAs, psychologists, physicians, and other providers.
• Manage provider recredentialing.
• Submit provider demographic updates.
• Process provider additions and terminations.
• Maintain provider credentialing records.

Medicaid & Commercial Payer Enrollment

• Manage enrollments with Medicaid and commercial payers, including:
• Georgia Medicaid (GAMMIS)
• CareSource
• Amerigroup
• Anthem BCBS
• Aetna
• Cigna / Evernorth
• UnitedHealthcare / Optum
• Humana
• Molina
• Additional commercial insurance plans

Payer Relationship Management

• Contact insurance companies to resolve credentialing delays.
• Escalate unresolved enrollment issues.
• Follow up on pending applications.
• Resolve provider roster discrepancies.
• Investigate payer denials related to credentialing.
• Coordinate with payer representatives to ensure timely approvals.

Contract Management

• Review provider participation agreements.
• Negotiate reimbursement rates when appropriate.
• Negotiate contract terms with commercial payers.
• Track contract effective dates.
• Monitor contract renewal deadlines.
• Maintain executed payer agreements.

CAQH & Provider Maintenance

• Maintain CAQH profiles.
• Ensure provider documents remain current.
• Track expiring licenses, malpractice insurance, DEA (if applicable), and certifications.
• Maintain credentialing database.

Reporting

• Maintain credentialing tracker.
• Report application status.
• Monitor turnaround times.
• Track payer approval timelines.
• Identify credentialing bottlenecks.

Required Qualifications

• Minimum 5 years of U.S. healthcare credentialing experience
• Minimum 3 years of ABA credentialing experience
• Extensive experience credentialing:
  • BCBAs
  • Psychologists
  • Physicians
  • ABA clinics
• Experience credentialing with both Medicaid and commercial insurance companies.
• Experience managing provider enrollments from start to finish.
• Experience calling insurance companies to resolve credentialing issues.
• Experience following up on delayed applications.
• Experience maintaining CAQH.
• Excellent spoken and written English.
• Strong negotiation skills.
• Excellent organizational skills.

Preferred Experience

• Experience credentialing with:
  • Georgia Medicaid (GAMMIS)
  • ABA organizations
  • Multi-state provider groups
  • Multi-location clinics
• Experience using:
  • CAQH
  • Availity
  • Provider portals
  • Microsoft Excel
  • Google Sheets
  • Monday.com (preferred)

Required Skills

• Outstanding verbal communication.
• Strong phone etiquette.
• Ability to confidently communicate with payer representatives.
• Highly organized.
• Strong follow-up skills.
• Detail-oriented.
• Excellent time management.
• Problem-solving mindset.
• Ability to manage multiple credentialing projects simultaneously.

Technical Requirements

• Laptop with at least:
  • Intel Core i5 (or equivalent)
  • 8 GB RAM
  • Webcam
  • Stable high-speed internet
  • Quiet workspace for daily phone calls

Compensation

• Competitive (based on experience)
• Remote.
• Independent Contractor.

At Fiesta Health , we believe that a diverse, inclusive, and equitable workplace is essential to our mission of delivering compassionate, high-quality care. We are proud to be an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or expression, national origin, age, disability, veteran status, or any other legally protected characteristic. We are committed to building a team that represents a variety of backgrounds, perspectives, and skills—because the more inclusive we are, the better we can serve our community.

Originally posted on Himalayas