ABA Credentialing Specialist: Compliance & Payer Support

Children's Specialized ABA; New Jersey; On-site; USD 55,000 - 70,000; Full time

Job summary

Children’s Specialized ABA is seeking a detail-oriented ABA Credentialing Specialist to support credentialing and re-credentialing of providers across the organization. The role ensures compliance with insurance payer requirements, state and federal regulations, and company policies.

The ideal candidate will manage multiple priorities, communicate with providers and payers, and maintain accurate documentation within the EHR system. Reports to the Director of Payer Services.

Qualifications

• High school diploma or equivalent (GED) required.
• 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.
• Strong analytical, problem-solving, and customer service skills.
• Ability to multitask and effectively track multiple providers, applications, deadlines, and outstanding items simultaneously.
• 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 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.

Skills

Attention to detail

Organizational and time-management

Analytical and problem-solving

Customer service

Verbal and written communication

Multitasking

Microsoft Office

Google Sheets

Google Docs

EHR systems navigation

Education

High school diploma or GED

Tools

Microsoft Office

Google Sheets

Google Docs

EHR systems

Insurance portals

Job description

Children’s Specialized ABA is seeking a detail-oriented ABA Credentialing Specialist to support credentialing and re-credentialing of providers across the organization. The role ensures compliance with insurance payer requirements, state and federal regulations, and company policies.

The ideal candidate will manage multiple priorities, communicate with providers and payers, and maintain accurate documentation within the EHR system. Reports to the Director of Payer Services.