Credentialing Specialist

Therapy and Beyond - ABA Therapy; Flower Mound (TX); On-site; USD 45,000 - 60,000; Full time

Job summary

Therapy & Beyond is seeking a detail-oriented Credentialing Specialist to obtain, verify, and maintain credentials, licensure, and insurance for clinical staff in Texas and Oklahoma.

You will support the revenue cycle by ensuring accurate credentialing, minimizing billing disruptions, and enabling providers to serve their communities with compliant records.

Qualifications

• High School Diploma or GED required; Bachelor's degree preferred in Health Administration, Business, or related field.
• Minimum of 2 years of experience in medical billing, credentialing, provider enrollment, or medical office administration.
• Proficiency with provider enrollment platforms (Medicare, Medicaid, Commercial Payers).
• Strong knowledge of medical credentialing policies, healthcare regulations, and accreditation standards.
• Exceptionally accurate data entry and document verification.
• Strong verbal and written communication with clinicians and insurers.

Responsibilities

• Database Management: Create and maintain digital records of provider licenses, credentials, and malpractice insurance.
• Proactive Compliance: Monitor license/DEA/board certs and insurance expiration; issue renewal notices in advance.
• Verification Liaison: Act as primary contact for external agencies, hospitals, and payers requesting verification.
• Regulatory Research: Stay updated on state, federal, and payer regulations (NCQA, CMS).
• Process Optimization: Help develop and revise credentialing SOPs to improve workflow and data integrity.
• Audit Readiness: Ensure readiness for internal or external audits at any time.

Skills

Attention to detail

Communication

Time management

Independent work

Team collaboration

Education

High School Diploma or GED

Bachelor’s degree in Health Administration, Business, or related field

Tools

Medicare enrollment platforms

Medicaid enrollment platforms

CAQH, PECOS, NPPES databases

Job description

Company Description

Therapy & Beyond is one of the largest BCBA-owned ABA organizations, founded and led by Dr. Regina Crone, BCBA-D. Through a collaborative, interdisciplinary approach to care, we partner with experts in Applied Behavior Analysis (ABA), Speech-Language Pathology, and Occupational Therapy. Our mission is rooted in four core values:

Putting People First, Doing Our Best Together, Making Therapy Fun, and Above All—We Grow Potential!

Job Description

We are seeking a detail-oriented Credentialing Specialist to serve as a vital component of our home office team. This role will be responsible for obtaining, verifying, and maintaining the credentials, licensure, and insurance coverage for our clinical staff in Texas and Oklahoma. By ensuring accurate and timely credentialing, you will directly support the revenue cycle, minimize billing disruptions, and ensure our providers are able to serve their communities.

Key Responsibilities

• Database Management: Create and maintain comprehensive digital records of provider licensing, credentials, and malpractice insurance. Manage provider profiles in industry databases (e.g., CAQH, PECOS, NPPES) with high accuracy.
• Proactive Compliance: Monitor expiration dates for licenses, DEA certificates, board certifications, and insurance policies. Issue "renew by" notifications to staff and management well in advance to prevent coverage lapses.
• Verification Liaison: Act as the primary point of contact for external agencies, hospitals, and commercial payers requesting verification of provider information.
• Regulatory Research: Stay current on updated state, federal, and payer-specific regulations (including NCQA and CMS standards) to ensure organizational policies remain compliant.
• Process Optimization: Assist in developing and revising internal credentialing Standard Operating Procedures (SOPs) to improve workflow efficiency and data integrity.
• Audit Readiness: Ensure the facility and all staff members maintain continuous compliance to ensure readiness for internal or external audits at any time.

Qualifications

• Required: High School Diploma or GED. Bachelor’s degree or college coursework in Health Administration, Business, or a related field.
• Preferred: Minimum of 2 years of experience in medical billing, credentialing, provider enrollment, or medical office administration.
• Proficiency with provider enrollment platforms (Medicare, Medicaid, Commercial Payers).
• Strong knowledge of medical credentialing policies, healthcare regulations, and accreditation standards.
• Exceptional accuracy in data entry and document verification.
• Communicator: Strong verbal and written communication skills, with the ability to speak professionally with clinicians and insurance representatives.
• Organizer: Ability to meet strict deadlines and prioritize tasks in a fast-paced environment without compromising quality.
• Team Player: Willingness to collaborate with the billing and authorization teams while possessing the self-discipline to work independently.