ABA Credentialing Pro - Payer & Compliance

Children's Specialized ABA; Maryland City (MD); Sur place; USD 45 000 - 65 000; Plein temps

Résumé du poste

Children’s Specialized ABA is seeking a credentialing specialist to support the credentialing and re-credentialing of providers across our organization in the United States. The role requires meticulous attention to detail and strong organizational skills.

You will manage credentialing processes, verify BCBA credentials, and communicate with providers and payers to obtain information and resolve items. Proficiency with EHRs and credentialing platforms is essential.

Qualifications

• High school diploma or equivalent (GED) required.
• 2+ years of experience in authorizations, medical insurance, billing, claims processing, credentialing, or related healthcare administrative function.
• ABA or Behavioral Health experience preferred.
• Strong attention to detail with excellent organizational and time-management skills.
• Strong analytical, problem-solving, and customer service skills.
• Ability to multitask and track multiple providers, applications, deadlines, and outstanding items.
• Excellent verbal, written, and interpersonal communication skills; professional phone and email communication.
• Proficiency in Microsoft Office, Google Sheets, and Google Docs, with ability to learn EHR systems and credentialing platforms.

Responsabilités

• Manage the credentialing and re-credentialing process for ABA professionals, ensuring compliance with applicable state, federal, insurance, and organizational requirements.
• Verify and maintain credentials for Board Certified Behavior Analysts (BCBAs), licensed ABA professionals, and other applicable practitioners.
• Communicate with providers and insurance payers throughout the credentialing process to obtain required information and resolve outstanding items.
• Review and process documentation for initial credentialing and re-credentialing applications.
• Ensure credentialing records are accurate, complete, current, and aligned with payer and regulatory requirements.
• Maintain approval dates, expiration dates, and other credentialing information within the EHR system.
• Proactively follow up with providers regarding missing documentation, upcoming expirations, renewals, and credentialing deadlines.
• Respond to credentialing inquiries and provide timely status updates to providers and internal stakeholders.
• Assist providers with credentialing profiles and payer portals, including troubleshooting issues and answering questions regarding requirements and processes.
• Stay current on Medicaid guidelines, payer requirements, regulatory changes, and policies impacting ABA credentialing.
• Support credentialing audits and communicate inactive, expired, pending, or fully credentialed provider statuses to appropriate departments.
• Maintain organized records and track multiple credentialing items simultaneously to ensure deadlines are met.

Connaissances

Attention to detail

Time management

Communication skills

Multi-tasking

Microsoft Office

Google Sheets

Google Docs

EHR systems

Formation

High school diploma or equivalent

Outils

Microsoft Office

Google Sheets

Google Docs

EHR systems

Description du poste

Children’s Specialized ABA is seeking a credentialing specialist to support the credentialing and re-credentialing of providers across our organization in the United States. The role requires meticulous attention to detail and strong organizational skills.

You will manage credentialing processes, verify BCBA credentials, and communicate with providers and payers to obtain information and resolve items. Proficiency with EHRs and credentialing platforms is essential.