Credentialing Specialist

Little Leaves•Silver Springs, NY

About The Position

Little Leaves provides full insurance support to families who seek our services. The Credentialing Specialist is responsible for managing the end-to-end provider credentialing and enrollment process to ensure all providers are properly enrolled, affiliated, and eligible to bill for services. This role is critical to maintaining billing readiness, compliance, and revenue flow by ensuring providers are credentialed accurately and timely across MD, VA, and FL markets.

Requirements

2+ years of provider credentialing experience (behavioral health or ABA preferred)
Experience working with commercial payers (UHC/Optum, Aetna, Cigna, BCBS, Kaiser, etc.)
Strong knowledge of CAQH management and provider enrollment processes
Experience with multi-state credentialing (MD, VA, FL preferred)
Understanding of state-specific licensure and payer enrollment requirements
Highly organized with strong attention to detail and follow-through
Strong communication and problem-solving skills
Proficiency in Excel and tracking tools
Ability to manage high-volume workflows and meet deadlines
Ability to maintain confidentiality and comply with HIPAA regulations

Nice To Haves

Experience with practice management systems (e.g., Central Reach, Motivity) preferred

Responsibilities

Manage initial credentialing, recredentialing, and revalidation for all providers across multiple payers and states (MD, VA, FL)
Maintain and update CAQH profiles, ensuring accuracy of provider demographics, licensure, and documentation
Ensure providers are properly affiliated with correct TINs, service locations, and state licensure requirements
Track and manage all applications using a centralized credentialing tracker
Proactively follow up with payers on pending applications (30/60/90+ days)
Escalate credentialing delays and unresolved issues through payer channels and leadership
Collaborate with billing, authorization, and clinical teams to ensure providers are cleared for billing
Identify and resolve credentialing discrepancies that may impact claims submission or reimbursement
Maintain accurate documentation of credentialing activities in internal systems
Support onboarding of new providers to ensure timely credentialing and minimal service disruption
Assist with payer demographic updates, roster submissions, and contract-related updates
Review and respond to payer correspondence related to credentialing status
Perform audits to ensure alignment between credentialing records and billing systems
Performs other duties as assigned