ABA Credentialing Specialist: Payer & Compliance

Children's Specialized ABA; New York (NY); On-site; USD 45,000 - 65,000; Full time

Job summary

Children’s Specialized ABA is seeking a 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.

You will manage documentation accuracy, navigate payer portals, and collaborate with internal teams to maintain up-to-date credentials and timely renewals. Strong communication with providers and payers is essential.

Qualifications

• High school diploma or GED required.
• At least 2 years in authorizations, medical insurance, billing, claims processing, credentialing, or related healthcare administrative function.
• Experience with insurance payers or healthcare provider documentation preferred.
• ABA or Behavioral Health experience preferred.
• Strong attention to detail with organizational and time-management skills.
• Strong analytical, problem-solving, and customer service skills.
• Ability to multitask and track multiple providers, applications, deadlines, and items.
• Excellent verbal and written communication, including professional phone and email.
• Proficiency in Microsoft Office, Google Docs/Sheets; ability to learn EHR systems and credentialing portals.

Responsibilities

• Manage credentialing and re-credentialing processes for ABA professionals in line with state, federal, payer, and organizational requirements.
• Verify and maintain credentials for BCBAs, licensed ABA professionals, and other practitioners.
• Communicate with providers and payers to obtain information and resolve items.
• Review and process documentation for initial credentialing and re-credentialing applications.
• Ensure credentialing records are accurate, current, and compliant with requirements.
• Maintain approval and expiration dates within the EHR system.
• Follow up on missing documentation and upcoming expirations and deadlines.
• Respond to credentialing inquiries and provide status updates to stakeholders.
• Assist providers with credentialing profiles and payer portals, troubleshooting as needed.
• Stay current on Medicaid guidelines and regulatory changes affecting credentialing.
• Support credentialing audits and communicate provider statuses to relevant departments.
• Maintain organized records and track multiple credentialing items to meet deadlines.

Skills

Attention to detail

Time management

Organizational skills

Verbal and written communication

Customer service

Multitasking

Microsoft Office

Google Sheets

Google Docs

Education

High school diploma or GED

Tools

EHR systems

Payer portals

Job description

Children’s Specialized ABA is seeking a 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.

You will manage documentation accuracy, navigate payer portals, and collaborate with internal teams to maintain up-to-date credentials and timely renewals. Strong communication with providers and payers is essential.