Credentialing Specialist

Kind Behavioral Health • Raleigh, NC

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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 quick entry into providing ABA services for clinicians. The specialist will partner closely with HR, Training, Clinical Leadership, Scheduling, and Billing to ensure credentialing does not become a barrier to care. Responsibilities include managing the full submission lifecycle for each application, ensuring clinician credentials are up-to-date and stored appropriately for audits, and overseeing the BACB RBT Requirements Coordinator process. The role also involves serving as the primary contact with payor credentialing departments, building relationships, maintaining a proactive follow-up cadence, and escalating issues when necessary. Additionally, the specialist will maintain a payor credentialing matrix, track payor-specific patterns to drive process changes, maintain a live credentialing tracking system, use data to identify root causes of delays and denials, and define and track key credentialing KPIs for reporting. The role also focuses on process improvement, documenting workflows, identifying gaps, and building standardized credentialing tools to reduce rework and improve first-pass approval rates and time-to-credential.

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—not just maintain what was handed to you.
• Comfort analyzing credentialing data to surface patterns: which payors run slow, which rejection reasons recur, and where cycle times are longest and why.
• Bachelor’s degree or equivalent professional experience.

Nice To Haves

• Familiarity with Medicaid MCOs and/or TRICARE is a plus given our payor mix in NC and GA.
• CentralReach experience preferred; not required.

Responsibilities

• Manage end-to-end credentialing and re-credentialing for BCBAs and RBTs across all contracted payors—initial enrollment, recredentialing, ongoing updates, and active status maintenance.
• Own the full submission lifecycle for each application: compiling all documentation, portal submission, follow-up, and resolution, with 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 to support audit readiness at any time.
• Coordinate with HR, Training, Clinical, and Scheduling to ensure credential status never blocks a clinician’s start date without advance warning.
• Help clinicians navigate the credentialing process, providing them with the resources and supports needed to smoothly navigate this process.
• Oversee the BACB RBT Requirements Coordinator process, working closely with the clinicians managing RBT supervision KBH-wide, including BACB portal maintenance, and timely responses to BACB supervision audits.
• Serve as KBH’s primary contact with payor credentialing departments, building relationships with payors, maintaining a proactive follow-up cadence, and escalating directly when timelines are at risk.
• Build and maintain a payor credentialing matrix documenting all payor-specific portal requirements, submission formats, re-credentialing cadence, common rejection reasons, key contacts, and escalation paths.
• Track payor-specific patterns, such as credentialing timelines, rejection reasons, documentation requirements, etc. and use those patterns to drive process changes.
• Maintain a live credentialing tracking system that provides real-time visibility into every active application: current status, outstanding items, payor, and estimated credentialing date.
• Use data to surface 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, and first-pass approval rate) and provide regular reporting to support staffing and revenue forecasting.
• Document current-state workflows and handoffs across HR, Training, Clinical, Scheduling, and Billing; identify gaps, redundancies, and bottlenecks.
• Build and maintain standardized credentialing tools: checklists, templates, submission packets, naming conventions, and SOPs that reduce rework and make the process transferable.
• Drive continuous improvement in first-pass approval rates and time-to-credential. If something is slowing things down, own the fix.

Benefits

• We are committed to creating a diverse environment and we are proud to be an equal opportunity employer.

What This Job Offers

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