ABA Credentialing Specialist: Compliance & Payer Navigator

Children's Specialized ABA; Clayton (NC); On-site; USD 45,000 - 65,000; Full time

Job summary

Children’s Specialized ABA seeks a detail-oriented Credentialing Specialist to manage the credentialing and re-credentialing of ABA professionals. You will coordinate with providers, payers, and internal teams to ensure documentation is accurate and timely.

The role requires experience with authorizations, medical insurance, billing, or credentialing, and strong organizational and communication skills. Proficiency with EHR systems and credentialing portals is essential, with ongoing attention to

Qualifications

• 2+ years of experience in authorizations, medical insurance, billing, claims processing, credentialing, or a related healthcare administrative function.
• Experience working with insurance payers and/or healthcare provider documentation preferred.
• ABA or Behavioral Health experience preferred.
• Strong attention to detail with excellent organizational and time-management skills.
• Exceptional verbal, written, and interpersonal communication skills, including professional phone and email communication.
• Proficiency in Microsoft Office, Google Sheets, and Google Docs, with strong overall computer skills.
• Ability to learn and navigate EHR systems, insurance portals, and other credentialing platforms.

Responsibilities

• 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 BCBA, 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.

Skills

Attention to detail

Organizational skills

Time management

Verbal and written communication

Multitasking

Analytical problem-solving

Customer service

Computer literacy

Education

High school diploma or GED

Tools

Microsoft Office

Google Sheets

Google Docs

EHR systems

Insurance portals

Credentialing platforms

Job description

Children’s Specialized ABA seeks a detail-oriented Credentialing Specialist to manage the credentialing and re-credentialing of ABA professionals. You will coordinate with providers, payers, and internal teams to ensure documentation is accurate and timely.

The role requires experience with authorizations, medical insurance, billing, or credentialing, and strong organizational and communication skills. Proficiency with EHR systems and credentialing portals is essential, with ongoing attention to