{bc}
Apply
paycor

Lead Credentialing Specialist

Already Autism Health
Remote, USA
Full-time
Entry · 2+ years experience
Remote
Discovered 1 months ago
CAQHHIPAA

Full Job Posting

  • Serve as the lead subject matter expert for credentialing, recredentialing, provider enrollment, and payer participation processes across assigned providers, payers, and markets.
  • Provide day-to-day guidance, coaching, and support to Credentialing Specialists and other team members regarding credentialing requirements, payer-specific processes, documentation standards, and enrollment issues.
  • Review credentialing and enrollment work completed by Credentialing Specialists for accuracy, completeness, compliance, and adherence to established policies, procedures, and payer requirements.
  • Conduct quality-control reviews of provider files, credentialing applications, primary source verifications, CAQH profiles, payer submissions, and enrollment records prior to final submission when required.
  • Monitor team credentialing workloads, aging applications, pending items, expirables, payer requests, and onboarding deadlines; identify bottlenecks and proactively escalate issues that may impact provider start dates, network participation, authorizations, or revenue.
  • Serve as the first-level escalation point for complex credentialing, enrollment, recredentialing, payer, and provider participation issues and coordinate resolution with payer representatives and internal leadership.
  • Maintain and communicate payer-specific credentialing requirements, workflows, submission procedures, and documentation standards to ensure consistent execution across the credentialing team.
  • Manage the credentialing, recredentialing, and payer enrollment processes for ABA and Diagnostic Services providers.
  • Coordinate provider onboarding activities related to credentialing and insurance participation.
  • Prepare, complete, and submit enrollment applications to commercial insurance plans, Medicaid programs, and other applicable payer networks.
  • Monitor application status and proactively follow up with payers to ensure timely approval and network participation
  • Maintain accurate provider records within credentialing databases and other internal systems.
  • Collect, verify, and maintain required provider documentation, including: Professional licenses Board certifications NPI registrations CAQH profiles Background checks Continuing education documentation
  • Professional licenses
  • Board certifications
  • NPI registrations
  • CAQH profiles
  • Background checks
  • Continuing education documentation
  • Perform primary source verification activities as required by organizational policy and payer requirements.
  • Monitor and track license renewals, certifications, malpractice coverage, and other expirable credentials to ensure ongoing compliance.
  • Maintain provider CAQH profiles and ensure all information is current and accurate.
  • Research and resolve credentialing, contracting, enrollment, and recredentialing issues with payers.
  • Partner with Operations, Revenue Cycle, Human Resources, Clinical Leadership, and Compliance teams to ensure providers are fully credentialed and enrolled before rendering services.
  • Assist with audits, payer requests, accreditation reviews, and compliance initiatives.
  • Generate credentialing reports and maintain documentation supporting regulatory and payer requirements.
  • Support credentialing process improvements that enhance efficiency, reduce payer turnaround times, and improve provider onboarding experiences.
  • Maintain confidentiality of provider and organizational information in accordance with HIPAA and organizational policies.
  • Assume designated lead responsibilities in the absence of the Director of Credentialing and Contracting, including prioritizing urgent credentialing matters, coordinating team workflow, and escalating critical issues to appropriate leadership.
  • Associate's degree required; Bachelor's degree preferred.
  • Equivalent combinations of education and credentialing experience may be considered.
  • Minimum of 2 years of credentialing, provider enrollment, healthcare administration, or related experience preferred.
  • Experience credentialing and enrolling behavioral health providers, ABA providers, and/or diagnostic clinicians strongly preferred.
  • Experience working with Medicaid managed care organizations and commercial payers preferred.
  • Experience with credentialing software, payer portals, and CAQH required.
  • Experience within ABA therapy, autism services, behavioral health, pediatric healthcare, or a related specialty healthcare setting.
  • Experience supporting de novo clinic launches, acquisitions, and integration activities.
  • Experience working in a high-growth, private equity-backed healthcare environment.

Apply for this job in 1 click

Skip the repetitive application forms

Install the Base Career Chrome Extension and autofill job applications across major job boards with your profile.

Sarah M.James T.Maya R.

Trusted by over 500,000 job seekers on Base Career

Start Free Today

More from this employer

More jobs at Already Autism Health

Registered Behavior Technician - In Home Charleston SC

Charleston, USA

Discovered 1 weeks agoFull-time

Lead Registered Behavior Technician - Morehead, KY

, USA

Discovered 1 weeks agoFull-time

Lead Registered Behavior Technician/Behavior Support Specialist - Morehead, KY

, USA

Discovered 1 weeks agoFull-time

Part-Time Registered Behavior Technician - Rincon, GA

Rincon, USA

Discovered 1 weeks agoPart-time

Registered Behavior Technician - Raleigh, NC

Raleigh, USA

Discovered 1 months agoFull-time

Registered Behavior Technician - Savannah, GA (Park of Commerce Way)

Savannah, USA

Discovered 1 months agoFull Time, Part Time

Registered Behavior Technician, RBT - Norton, VA

Norton, USA

Discovered 1 months agoFull-time

Part-Time Board Certified Behavior Analyst (BCBA) - In Home

Columbia, USA

Discovered 1 months agoPart-time