Credentialing Specialist

Behavioral Health Network, Inc.; Springfield (MA); On-site; USD 33,000 - 37,000; Full time

Benefits offered by this job

Generous PTO

403(b)

Educational assistance

Medical insurance

Dental insurance

Vision insurance

Employee assistance program

Job summary

Behavioral Health Network, Inc. seeks a credentialing professional to manage initial and recredentialing applications for clinicians, verify credentials, and monitor licensure and sanctions.

You will coordinate with the credentialing committee and ensure accuracy of staff credentials and insurance eligibility. Role requires familiarity with PECOS, NPI, CAQH, and insurance contracts; strong attention to detail and ability to escalate issues to the Clinical Director.

Qualifications

• High school diploma or GED required.
• Knowledge of insurance, clinical license levels and educational degrees, CPT coding, and guarantor credentialing standard required.
• Familiarity with PECOS, NPI, CAQH, OIG exclusion list and Med Advantage required.
• Insurance background with coding and billing required.

Responsibilities

• Processes individual provider initial credentialing applications, and biennial recredentialing applications.
• Assists in onboarding clinical staff by verifying credentials, identity, degrees, certification, work history, etc.
• Monitors electronic credentialing workflow. Evaluates the quality of information provided by the CVO and escalates exceptions to the Clinical Director for review.
• Ensures each individual credentialing application is processed by the credentialing committee for all initial and recredentialed clinical staff.
• Monitors State Professional Licensure, Board Certification, DEA, CDS and other credentials as required. Reviews for pending expiration dates and follows up with staff to ensure their compliance.
• Reviews CredentialStream alerts for State exclusions and professional licensing sanctions, OIG exclusions, SAM exclusions, Federal Sanctions, and notifies the Clinical Director of all identified concerns.
• Maintains database of credentialed staff in CredentialStream, which includes staff credentials and insurance eligibility.
• Prepares payer rosters and delegates credentialing oversight reports using the cadence defined by each insurance company.
• Enrolls and empanels eligible clinical staff as determined by insurance contracts.

Skills

Insurance knowledge

Clinical license knowledge

CPT coding

PECOS familiarity

Education

High school diploma or GED

Tools

CredentialStream

State licensure checks

Job description

What We Offer:

• Purpose-Driven Work - Make a meaningful impact in the lives of individuals, families, and communities throughout Western Massachusetts.
• Professional Growth - Access ongoing training, mentorship, career development, and advancement opportunities across one of the region's largest behavioral health organizations.
• Supportive Team Culture - Join a collaborative workplace guided by our HEART values: Humanity, Empowerment, Accountability, Respect, and Teamwork.
• Stability & Opportunity - Build your career with a well-established organization serving Western Massachusetts since 1938.
• Comprehensive Benefits - Generous PTO, 403(b), educational assistance, medical, dental, vision, employee assistance programs, and more.
• Certified Great Place to Work - Work for an organization recognized for creating a positive and engaging employee experience.

What You Will Do:

• Processes individual provider initial credentialing applications, and biennial recredentialing applications.
• Assists in onboarding clinical staff by verifying credentials, identity, degrees, certification, work history, etc.
• Monitors electronic credentialing workflow. Evaluates the quality of information provided by the CVO and escalates exceptions to the Clinical Director for review.
• Ensures each individual credentialing application is processed by the credentialing committee for all initial and recredentialed clinical staff.
• Monitors State Professional Licensure, Board Certification, DEA, CDS and other credentials as required. Reviews for pending expiration dates and follows up with staff to ensure their compliance.
• Reviews CredentialStream alerts for State exclusions and professional licensing sanctions, OIG exclusions, SAM exclusions, Federal Sanctions, and notifies the Clinical Director of all identified concerns.
• Maintains database of credentialed staff in CredentialStream, which includes staff credentials and insurance eligibility.
• Prepares payer rosters and delegates credentialing oversight reports using the cadence defined by each insurance company.
• Enrolls and empanels eligible clinical staff as determined by insurance contracts.

Who You Are:

• High school diploma or GED required.
• Knowledge of insurance, clinical license levels and educational degrees, CPT coding, and guarantor credentialing standard required.
• Familiarity with PECOS, NPI, CAQH, OIG exclusion list and Med Advantage required.
• Insurance background with coding and billing required.

PAY RANGE - $24.00 - $27.00 per hour - based upon experience

We Hire for HEART!

Since 1938, BHN has delivered high-quality, culturally responsive behavioral health care, building deep roots in Western Massachusetts while expanding our impact in communities throughout the state. Our core values - Humanity, Empowerment, Accountability, Respect, and Teamwork - guide how we lead, serve, and support one another. If you're ready to bring your skills and experience to a mission-driven organization where your work can make a meaningful difference, we'd love to hear from you.

BHN is committed to social justice and diversity and strongly encourages diverse candidates to apply. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.