Credentialing Specialist

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

The organization operates within the Behavioral Health and Applied Behavior Analysis (ABA) industry, addressing the need for accurate and compliant credentialing of ABA professionals. It focuses on managing credentialing processes to meet insurance payer requirements as well as state and federal regulations, supporting providers and ensuring timely processing of credentialing documentation.

About the Opportunity:

The ABA CREDENTIALING SPECIALIST role is responsible for managing the credentialing and re-credentialing of ABA professionals to maintain compliance with regulatory and payer standards. This position ensures credentialing documentation is accurate and processed efficiently, facilitating provider participation in insurance networks. The role contributes to organizational compliance, provider readiness, and the smooth operation of credentialing processes.

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.

Requirements:

• High school diploma or equivalent.
• Minimum of 2 years' experience in authorizations, medical insurance, billing, claims processing, credentialing, or related healthcare administration.
• Preferred experience with insurance payers and healthcare provider documentation.
• Preferred experience in ABA or Behavioral Health.
• Strong attention to detail, organizational, and time-management skills.
• Analytical, problem-solving, and customer service skills.
• Ability to multitask and manage multiple provider applications and deadlines.
• Excellent verbal, written, and interpersonal communication skills.
• Proficiency with Microsoft Office, Google Sheets, and Google Docs.
• Ability to learn EHR systems, insurance portals, and credentialing platforms.

Pay Range and Compensation Package:

• The pay range and compensation package for this role will be determined based on the candidate's experience, skills, and other relevant factors.

Equal Opportunity Statement:

Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin.