ABA Credentialing Specialist - Payer Compliance & Records

TalentHop; United States; On-site; USD 60,000 - 85,000; Full time

Job summary

TalentHop in the United States specializes in credentialing ABA professionals to meet payer and regulatory requirements. The ABA Credentialing Specialist will manage credentialing and re-credentialing, ensuring documentation is accurate and processed efficiently to support provider participation in insurance networks.

You will maintain records, track expirations, communicate with providers and payers, stay updated on Medicaid guidelines, and assist with payer portal issues.

Qualifications

• High school diploma or equivalent required.
• 2+ years of experience in medical authorizations, billing, claims processing, credentialing, or related healthcare administration.
• Experience with insurance payers and healthcare provider documentation preferred.
• ABA or Behavioral Health experience is a plus.

Responsibilities

• Manage credentialing and re-credentialing processes for ABA professionals in compliance with state, federal, insurance, and organizational requirements.
• Verify and maintain credentials for Board Certified Behavior Analysts and licensed ABA practitioners.
• Communicate with providers and insurance payers to obtain required information and resolve credentialing issues.
• Review and process credentialing documentation for initial and renewal applications.
• Maintain accurate and current credentialing records aligned with payer and regulatory standards.
• Track approval and expiration dates within the electronic health record system.
• Follow up with providers on missing documentation and credentialing deadlines.
• Provide timely status updates and respond to credentialing inquiries.
• Assist providers with credentialing profiles and payer portal issues.
• Stay updated on Medicaid guidelines, payer requirements, and regulatory changes affecting ABA credentialing.
• Support credentialing audits and communicate provider credentialing statuses to relevant departments.
• Organize records and manage multiple credentialing items to meet deadlines.

Skills

Attention to detail

Organizational skills

Communication

Time management

Multitasking

Education

High school diploma

Tools

Microsoft Office

Google Sheets

Google Docs

EHR systems

Insurance portals

Job description

TalentHop in the United States specializes in credentialing ABA professionals to meet payer and regulatory requirements. The ABA Credentialing Specialist will manage credentialing and re-credentialing, ensuring documentation is accurate and processed efficiently to support provider participation in insurance networks.

You will maintain records, track expirations, communicate with providers and payers, stay updated on Medicaid guidelines, and assist with payer portal issues.