Credentialing Specialist

Kind Behavioral Health • Raleigh, NC

7h • Remote

About The Position

Kind Behavioral Health is seeking a Credentialing Specialist to manage the end-to-end credentialing and re-credentialing process for BCBAs and RBTs across all contracted payors. This role is crucial for ensuring timely access to care for families and enabling clinicians to begin providing ABA services promptly. The specialist will be responsible for workflows, tools, and relationships that ensure credentialing operates reliably at scale. This position requires close collaboration with HR, Training, Clinical Leadership, Scheduling, and Billing to prevent credentialing from becoming a barrier to care. The role involves proactive engagement with payors, including follow-up, escalation when necessary, and building relationships with credentialing contacts to uphold best practices and ensure accountability among all stakeholders.

Requirements

• Prior credentialing or provider enrollment experience in a healthcare setting (required).
• ABA provider credentialing experience with experience credentialing both BCBAs and RBTs strongly preferred.
• Hands-on experience with CAQH, NPI, and commercial + government payor portals.
• Demonstrated best practices for maintaining audit-ready provider files.
• Proven ability to build or improve credentialing processes (SOPs, tracking tools, checklists).
• Comfort analyzing credentialing data to surface patterns.
• Bachelor’s degree or equivalent professional experience.

Nice To Haves

• Familiarity with Medicaid MCOs and/or TRICARE.
• CentralReach experience preferred.

Responsibilities

• Manage end-to-end credentialing and re-credentialing for BCBAs and RBTs across all contracted payors, including initial enrollment, recredentialing, ongoing updates, and active status maintenance.
• Own the full submission lifecycle for each application: compiling documentation, portal submission, follow-up, and resolution, maintaining a complete and auditable paper trail.
• Ensure clinician credentials and supporting documentation (BACB certification, BLS, Safety Care, NPI, CAQH, diplomas, state licenses as applicable) are current, verified, and stored for audit readiness.
• Coordinate with HR, Training, Clinical, and Scheduling to ensure credential status does not delay a clinician’s start date without advance notification.
• Assist clinicians in navigating the credentialing process by providing necessary resources and support.
• Oversee the BACB RBT Requirements Coordinator process, including BACB portal maintenance and timely responses to BACB supervision audits.
• Serve as the primary contact with payor credentialing departments, building relationships, maintaining a proactive follow-up cadence, and escalating issues when timelines are at risk.
• Build and maintain a payor credentialing matrix detailing payor-specific portal requirements, submission formats, re-credentialing cadence, common rejection reasons, key contacts, and escalation paths.
• Track payor-specific patterns (e.g., credentialing timelines, rejection reasons, documentation requirements) to drive process improvements.
• Maintain a live credentialing tracking system providing real-time visibility into active applications, including status, outstanding items, payor, and estimated credentialing date.
• Analyze data to identify root causes of delays and denials, prioritize process changes by impact, and demonstrate improvement over time.
• Define and track key credentialing KPIs (e.g., cycle time, aging by payor, touchpoints per application, first-pass approval rate) and provide regular reporting.
• Document current-state workflows and handoffs across departments; identify gaps, redundancies, and bottlenecks.
• Build and maintain standardized credentialing tools such as checklists, templates, submission packets, naming conventions, and SOPs.
• Drive continuous improvement in first-pass approval rates and time-to-credential.

Benefits

• Life-changing treatment to children with autism spectrum disorder (“ASD”)
• Outstanding quality care
• Exceptional clinical outcomes
• Environment in which all are encouraged to THINK BIG, HAVE FUN, DO GOOD, and BE KIND
• Individualized care plans
• Target socially significant behaviors
• Enabling clients to lead more independent, fulfilling lives
• Ensuring timely access to care for families
• Quick entry into providing ABA services for clinicians
• Partner closely with HR, Training, Clinical Leadership, Scheduling, and Billing
• Proactive and strong advocate with payors
• Following best practices and driving accountability with all stakeholders
• Support for audit readiness
• Advance warning of credentialing blocks
• Resources and supports for clinicians
• BACB portal maintenance
• Timely responses to BACB supervision audits
• Building relationships with payors
• Proactive follow-up cadence
• Escalating directly when timelines are at risk
• Maintaining a payor credentialing matrix
• Tracking payor-specific patterns
• Live credentialing tracking system
• Real-time visibility into every active application
• Data analysis for root causes of delays and denials
• Prioritizing process changes by impact
• Demonstrating improvement over time
• Defining and tracking key credentialing KPIs
• Regular reporting for staffing and revenue forecasting
• Documenting current-state workflows and handoffs
• Identifying gaps, redundancies, and bottlenecks
• Building and maintaining standardized credentialing tools
• Reducing rework and making the process transferable
• Continuous improvement in first-pass approval rates and time-to-credential
• Owning the fix for process slowdowns
• Commitment to creating a diverse environment
• Equal opportunity employer
• Knowledge of Autism and Behavior Analysis
• Opportunity to learn and grow
• Impact on children and families served

What This Job Offers

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