ABA Credentialing Specialist — Payer & Compliance

Children's Specialized ABA; Annapolis (MD); À distance; USD 52 000 - 68 000; Plein temps

Résumé du poste

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

The ideal candidate has experience with authorizations, medical insurance, billing, claims processing, or credentialing and excels at managing multiple priorities, communicating with providers and payers, and maintaining

Qualifications

• High school diploma or GED required.
• 2+ years of experience in authorizations, medical insurance, billing, claims processing, credentialing, or 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 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 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.
• Maintain credentialing records accurate, 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 statuses to appropriate departments.
• Maintain organized records and track multiple credentialing items to meet deadlines.

Connaissances

Attention to detail

Organizational skills

Time management

Communication skills

Customer service

Formation

High school diploma or GED

Outils

Microsoft Office

Google Sheets

Google Docs

EHR systems

Payer portals

Description du poste

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

The ideal candidate has experience with authorizations, medical insurance, billing, claims processing, or credentialing and excels at managing multiple priorities, communicating with providers and payers, and maintaining