Credentialing Specialist

ACES (Comprehensive Educational Services); United States; Remote; USD 40,000 - 55,000; Full time

Job summary

Join a rapidly growing company dedicated to enhancing the quality of life for individuals with autism as a Credentialing Specialist. This remote position involves ensuring clinical staff meet necessary certifications, managing databases, and supporting a collaborative work environment with ample opportunities for professional growth.

Benefits

Health, vision, and dental benefits

Paid vacation/sick time

Retirement options

Pet insurance

Opportunities for professional growth

Supportive work environment

Qualifications

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

Responsibilities

• Verify credentials and qualifications of providers.
• Maintain up-to-date provider files.
• Communicate with payors and complete funder applications.

Skills

Organizational skills

Communication skills

Problem-solving skills

Data entry

Education

High school diploma required

Associate's degree preferred

Tools

CAQH database

Job description

Join to apply for the Credentialing Specialist role at ACES (Comprehensive Educational Services)

Join to apply for the Credentialing Specialist role at ACES (Comprehensive Educational Services)

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About ACES:

Description

Location: Remote

Job Type: Full Time

Pay Rate: $23-$25 an hour

About ACES:

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 http://www.acesaba.com.

Position Summary:

At ACES, we are committed to elevating the standards in the treatment of autism. This means elevating the client's 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 Generalist’s 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

• Associates degree preferred. High school diploma required.
• 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
  
  

Benefits & Perks

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. (https://www.acesaba.com/employees-privacy-policy/)

If you are having any issues with submitting your application, please reach out to us directly at [e-mail].

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Individual and Family Services

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