Credentialing Specialist- 130703

Claratel Behavioral Health•Decatur, GA

8d•Hybrid

About The Position

Claratel Behavioral Health is seeking a dedicated and experienced Credentialing Specialist. This role is responsible for managing provider credentialing, payer enrollment, and maintaining payer relationships. The Credentialing Specialist serves as the primary liaison between the agency and payer therefore, playing a key role in optimizing revenue cycle performance.

Requirements

In-depth knowledge of credentialing, payer enrollment, and regulatory requirements
Proficient in CAQH maintenance and management
Intermediate proficiency in Excel
Strong analytical and problem-solving skills
Ability to develop strong collaborative working relationships with internal partners
Ability to manage multiple priorities simultaneously with strict and competing deadlines
Ability to adapt quickly to changing priorities
Highly self-motivated with strong organizational skills and attention to detail
Exercise sound judgement, including appropriate escalation of issues when necessary
Excellent interpersonal skills including the ability to interact effectively and professionally with individuals at all levels; both internal and external
Embraces and leverages technology to enhance efficiency
Must possess strong ethics and a high level of personal and professional integrity

Nice To Haves

CPCS- Certified Provider Credentialing Specialist

Responsibilities

Build and maintain strong relationships with Medicaid, Medicaid CMOs, and Commercial Payers
Serve as the primary point of contact for payer communications, issue resolution, and escalations
Attend Medicaid, CMO, and payer sponsored meetings and trainings
Manage end-to-end provider credentialing and recredentialing processes
Complete, track, and monitor payer enrollment applications for new payer contracts
Maintain accurate and up-to-date provider data
Maintain provider profiles in CAQH database
Enroll and manage staff access in payer portals including: GAMMIS, Availity, Palmetto GBA Portal
Ensure timely completion of attestations and revalidations
Monitor provider licensure, certifications, and renewals to ensure ongoing compliance
Track and verify sanctions, exclusions, and disciplinary actions (OIG, SAM, State Boards)
Monitor associate-level staff working toward full licensure and ensure proper payer alignment
Maintain all required credentialing documentation
Collaborate with HR and Clinical Leadership to support provider onboarding
Ensure data integrity and consistency across EHR, payer systems, and credentialing platforms
Provide regular status updates and timelines for leadership
Track and report on key credentialing and enrollment metrics (turnaround time, enrollment lag, recredentialing compliance)