Credentialing Specialist

Children's Specialized ABA•Remote, NJ

8h•$24 - $28

About The Position

Children’s Specialized ABA is seeking a detail-oriented and highly organized ABA Credentialing Specialist to support credentialing and re-credentialing of providers across the organization. The role manages credentialing processes for Behavioral Health and ABA professionals, ensuring compliance with insurance payer requirements, state and federal regulations, and company policies. The specialist works with providers, insurance payers, and internal departments to ensure documentation is accurate, complete, and processed in a timely manner. The role is open to candidates in NJ, MD, AZ, or NC and reports to the Director of Payer Services.

Requirements

High school diploma or equivalent (GED).
At least 2 years of experience in authorizations, medical insurance, billing, claims processing, credentialing, or a related healthcare administrative function.
Strong attention to detail and excellent organizational and time-management skills.
Strong analytical, problem-solving, and customer service skills.
Ability to multitask and track multiple providers, applications, deadlines, and outstanding items simultaneously.
Exceptional verbal, written, and interpersonal communication skills, including professional phone and email communication.
Proficiency in Microsoft Office, Google Sheets, and Google Docs, with strong overall computer skills.
Ability to learn and navigate EHR systems, insurance portals, and other credentialing platforms.

Nice To Haves

Experience working with insurance payers and/or healthcare provider documentation.
ABA or Behavioral Health experience.

Responsibilities

Manage credentialing and re-credentialing for ABA professionals in accordance with state, federal, insurance, and organizational requirements.
Verify and maintain credentials for Board Certified Behavior Analysts, licensed ABA professionals, and other applicable practitioners.
Communicate with providers and insurance payers to obtain required information and resolve outstanding items.
Review and process documentation for initial credentialing and re-credentialing applications.
Ensure credentialing records are accurate, complete, current, and aligned with payer and regulatory requirements.
Maintain approval dates, expiration dates, and other credentialing information in the EHR system.
Follow up with providers about missing documentation, upcoming expirations, renewals, and credentialing deadlines.
Respond to credentialing inquiries and provide timely status updates to providers and internal stakeholders.
Assist providers with credentialing profiles and payer portals, including troubleshooting issues and answering questions about requirements and processes.
Stay current on Medicaid guidelines, payer requirements, regulatory changes, and policies affecting ABA credentialing.
Support credentialing audits and communicate inactive, expired, pending, or fully credentialed provider statuses to appropriate departments.
Maintain organized records and track multiple credentialing items to ensure deadlines are met.