Credentialing Specialist

ACES; San Diego (CA); On-site; USD 100,000 - 125,000; Full time

Job summary

Join ACES as a Credentialing Generalist, where you will play a critical role in ensuring our clinical staff meet necessary standards to deliver high-quality ABA services. This position offers the opportunity for professional growth within a collaborative environment focused on enhancing lives of individuals with autism and related disorders.

Benefits

Health, vision, and dental benefits

Paid vacation and sick time

Retirement options

Pet insurance

Qualifications

• Minimum of 2 years credentialing experience.
• Experience with CAQH database and application process.
• Knowledge of credentialing regulations.

Responsibilities

• Verify credentials and qualifications of providers.
• Complete funder applications and maintain up-to-date provider files.
• Manage credentialing tasks assigned by the Associate Director.

Skills

Excellent communication skills

Organizational skills

Problem-solving skills

Tools

CAQH database

Job description

ACES is a rapidly growing autism services company dedicated to enhancing the quality of life for individuals and families impacted with autism or other special needs. We provide comprehensive professional services to maximize individuals potential in the home school and community throughout their lifespan.

ACES distinguished care is grounded in an industry-leading model of behavioral artistry which combines the best clinical practice of traditional Applied Behavioral Analysis (ABA) with humanistic elements that help our clients generalize their skills and gain independence. At 30 locations we are motivated to grow both so that we can serve more clients and close the significant supply gap that currently exists across the United States. We are committed to attracting and cultivating the very best team members who embody ACES values and culture and are passionate about our work. For more information visit .

Position Summary :

At ACES we are committed to elevating the standards in the treatment of autism. This means elevating the clients experience elevating clinical outcomes and elevating the team member experience and contribution all while finding new better and more efficient ways to provide care. Ensuring ACES does this in a standardized scalable way is critical for our rapidly growing company in this stage of our development.

We are seeking a highly organized and detail-oriented Credentialing Generalist to join our dynamic team at ACES. The Credentialing Generalist will play a crucial role in ensuring that our clinical staff members meet all necessary requirements certifications and licenses to deliver top-notch ABA services to our clients.

Under the supervision of the Associate Director of Credentialing Services (ADC) and Associate Manager of Credentialing Services (AMCS) the Credentialing Generalists day-to-day responsibilities are to verify the credentials and qualifications of providers process funder applications and maintain up-to-date provider files. ACES Credentialing Team operates under a POD level service. Each Generalist is assigned a specific POD that is regionally based and is responsible for all providers affiliated within their POD. The Credentialing Generalist will work closely with POD Leadership Recruitment and Scheduling to provide data each week to discuss goals and progress.

Qualifications

Job Duties / Responsibilities

CAQH management (update and maintain provider demographics upload essential documentation maintain attestations and re-attestations)

NPI : create / update / maintain provider demographics and request surrogacy (as needed)

Complete all PSV functions (background checks run and review exclusions lists verify education and training verify licensures ensure CV is up-to-date and provide proof of liability insurance

Completion of funder applications via Modio paper applications and funder portals

Provide consistent and timely follow-up on all outstanding credentialing and re-credentialing workloads

Detailed and consistent data entry into credentialing databases (PSV documentation payor submissions payor updates credentialing submission dates effective and end dates and maintain and update provider demographics)

Responsible for monitoring and managing credentialing and re-credentialing tasks assigned by ADC

Reports daily / weekly workload and projects updates and deadlines with AMCS

Prepare files for weekly Delegated Credentialing Committee meetings

Processes provider terminations assigned by ADC and reports terminations to funders for directory removal

Work on assigned RCM tasks (provider denials related to credentialing issues) and provide updates to Billing team

Attend weekly Credentialing Team and POD Team meetings.

Communicates with payors via phone email and / or fax on a regular basis for inquiries and updates related to submissions follow-ups or to obtain additional credentialing information

Participates in various educational trainings as required

Comply with HIPAA and Company compliance requirements

Always maintain confidentiality and privacy

Flexibility with assisting other team members in other PODS (if necessary) and taking on any additional tasks assigned by management

Qualifications

Minimum of 2 years credentialing experience

Experience with CAQH database and application process

Working knowledge of credentialing regulations policies and procedures

Performance Skills

Must be demonstrate excellent communication skills listens effectively and asks questions when clarification is needed

Demonstrates accuracy organizational and problem-solving skills

Must be able to work independently

Prioritize workload and projects and manage time efficiently

Must demonstrate and promote a positive team-oriented environment

Maintain confidentiality

ACES knows what it takes to deliver the highest level of care for our clients and we believe our team deserves to experience that care as well. We offer a robust benefit package including health vision and dental benefits paid vacation / sick time retirement options pet insurance and more including :

Competitive salary and benefits package.

Opportunities for professional growth and development.

A supportive and collaborative work environment.

The chance to make a meaningful impact in the lives of individuals with autism and related developmental disorders.

Additional Information

ACES is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race color religion sex gender gender identity sexual orientation marital status national origin disability age or covered veteran status. We embrace diversity and encourage you to apply! To find out more about how ACES uses employee data for business purposes see our Employee Privacy Policy. ( you are having any issues with submitting your application please reach out to us directly at

Required Experience :

Unclear Seniority

Key Skills

Employment Type : Unclear

Experience : years

Vacancy : 1

Monthly Salary Salary : 23 - 25

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