ABA Credentialing Specialist: Payer Compliance & Billing

Children's Specialized ABA; Kearny (NJ); In loco; USD 55.000 - 75.000; Tempo pieno

Descrizione del lavoro

Children's Specialized ABA seeks an ABA Credentialing Specialist to manage credentialing and re-credentialing for our providers, ensuring compliance with insurer requirements and state/federal regulations. You will maintain accurate records in the EHR, coordinate with payers, and support audits.

The ideal candidate has 2+ years in credentialing or related healthcare admin, with strong organizational skills, attention to detail, and the ability to juggle multiple providers and deadlines in a

Competenze

• 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.

Mansioni

• 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.

Conoscenze

Attention to detail

Organizational skills

Communication skills

Multitasking

Microsoft Office

EHR systems

Formazione

High school diploma or GED

Strumenti

Google Sheets

Google Docs

Descrizione del lavoro

Children's Specialized ABA seeks an ABA Credentialing Specialist to manage credentialing and re-credentialing for our providers, ensuring compliance with insurer requirements and state/federal regulations. You will maintain accurate records in the EHR, coordinate with payers, and support audits.

The ideal candidate has 2+ years in credentialing or related healthcare admin, with strong organizational skills, attention to detail, and the ability to juggle multiple providers and deadlines in a