ABA Credentialing Specialist

Behavioral Health Works

11d • Remote

About The Position

Behavioral Health Works is seeking a detail-oriented and organized Credentialing Specialist to support provider credentialing, enrollment and compliance activities across our growing multi-state organization. This fully remote position is responsible for coordinating provider credentialing and re-credentialing, managing payer enrollments, maintaining provider records and ensuring compliance with federal, state and payer requirements. The Credentialing Specialist will work closely with clinical, operations, billing and compliance teams to ensure providers are credentialed and enrolled accurately and efficiently so they can begin serving clients without delay.

Requirements

• Bachelor's degree in Healthcare Administration, Business Administration, Public Health or a related field preferred, or equivalent work experience.
• Minimum of 2 years of provider credentialing or healthcare enrollment experience.
• Experience with Medicaid, Medicare and commercial payer credentialing.
• Experience using CAQH, NPPES, CMS I&A, Availity or similar credentialing platforms.
• Strong understanding of provider credentialing and payer enrollment processes.
• Excellent organizational skills and attention to detail.
• Strong written and verbal communication skills.
• Proficiency with Google Workspace (Drive, Sheets, Forms) and Microsoft Office, including Excel, monday.com.

Nice To Haves

• Experience in ABA, behavioral health or outpatient healthcare.
• Experience with CentralReach or similar practice management software.
• Experience with multi-state provider credentialing and enrollment.
• Knowledge of accreditation standards and healthcare compliance requirements.
• Experience with state-specific provider enrollment portals (e.g., PAVE for California Medi-Cal, EICS for Massachusetts Early Intervention).

Responsibilities

• Coordinate provider credentialing and re-credentialing for BCBAs and other clinical providers across multiple states.
• Prepare, submit and track credentialing and enrollment applications with Medicaid, Medicare and commercial insurance payers.
• Maintain provider records including licenses, certifications, malpractice insurance and credentialing documentation.
• Monitor credentialing applications and proactively follow up with payers regarding application status.
• Complete provider revalidations and re-credentialing renewals before required deadlines.
• Maintain provider profiles within CAQH, NPPES, CMS I&A, Availity and other credentialing platforms.
• Ensure provider files remain complete, accurate and compliant with federal, state and payer requirements.
• Monitor provider licenses, certifications and credential expiration dates.
• Perform routine audits of provider files and credentialing records.
• Assist with monitoring OIG exclusions, SAM, state license sanctions and Medicare/Medicaid Opt-Out status.
• Maintain organized electronic credentialing files and documentation.
• Serve as a primary point of contact for providers regarding credentialing and enrollment questions.
• Communicate with insurance companies, Medicaid agencies and commercial payers regarding application status and required documentation.
• Assist providers with completing credentialing paperwork and obtaining required documents.
• Resolve credentialing issues and enrollment discrepancies promptly.
• Track credentialing and enrollment status using spreadsheets and internal systems.
• Prepare reports on credentialing activities, enrollment status and upcoming renewals.
• Identify opportunities to improve credentialing workflows and operational efficiency.
• Assist with maintaining SOPs, policies and credentialing documentation.
• Support accreditation and audit preparation as assigned.

Benefits

• Health, Dental, Chiropractic and Vision Insurance
• Critical Illness, Voluntary Life, Accident, Hospital Confinement and Basic Life Insurance
• 401(k)
• Pet Insurance
• Paid Time Off
• 7 Company-Paid Holidays per year
• Professional Development Assistance
• Employee Referral Program
• Tuition Reduction Programs through affiliated university partners

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level