Credentialing Specialist

Golden Steps ABA•Englewood Cliffs, NJ

1d•Hybrid

About The Position

Golden Steps ABA is seeking an organized and detail-oriented Credentialing Specialist to manage provider credentialing and payer enrollment across our growing, multi-state organization. This role helps ensure our clinicians are credentialed accurately and efficiently so they can begin providing services to children and families without unnecessary delays. The ideal candidate has experience with healthcare credentialing, Medicaid and commercial payer enrollment, CAQH, and NPI registration. You must be comfortable managing multiple applications, deadlines, and payer requirements in a fast-paced environment.

Requirements

High school diploma or equivalent.
At least two years of healthcare credentialing, provider enrollment, or payer enrollment experience.
Hands-on experience with CAQH and the NPI Registry.
Experience submitting applications to Medicaid and commercial insurance payers.
Strong attention to detail and commitment to maintaining complete, accurate records.
Ability to manage a high-volume workload with competing priorities and firm deadlines.
Strong written and verbal communication skills.
Effective problem-solving, follow-up, and organizational skills.
Proficiency with Microsoft Office or Google Workspace, including spreadsheets.
Ability to work independently while collaborating effectively across departments.

Nice To Haves

Experience in behavioral health, applied behavior analysis, pediatric therapy, or a multi-site healthcare organization.
Experience with multi-state Medicaid enrollment and state-specific credentialing requirements.
Familiarity with payer rosters, revalidations, contracting documentation, or credentialing audits.

Responsibilities

Complete initial credentialing, recredentialing, and payer enrollment applications for individual providers and applicable entities.
Enroll providers with Medicaid and commercial insurance plans based on payer and state requirements.
Research and maintain current knowledge of credentialing and enrollment requirements across assigned states.
Create and maintain accurate provider files, including licenses, certifications, education, employment history, attestations, and other required documentation.
Maintain CAQH profiles, including documentation updates and re-attestations.
Create and update National Provider Identifier (NPI) records when needed.
Complete payer revalidation and recredentialing requests within required deadlines.
Track applications from submission through approval and follow up with payers to address delays or missing information.
Maintain accurate records of payer applications, login credentials, approval dates, effective dates, and renewal requirements.
Identify missing, expired, or inconsistent provider information and coordinate timely resolution.
Communicate credentialing status, delays, risks, and next steps to leadership and internal partners.
Collaborate with Billing and Operations to support provider activation and accurate payer participation.
Assist with payer contracting documentation and credentialing audits as needed.
Protect confidential provider and organizational information.