Credentialing Specialist

Beacon Behavioral Partners•Plano, TX

3d•Onsite

About The Position

Beacon Behavioral Partners is seeking a Credentialing Specialist to join its Revenue Cycle Team. This full-time, onsite position is based at the company’s corporate office in Plano, Texas. The role supports provider enrollment and credentialing across a network of physician-driven psychiatric practices. The specialist maintains provider credentialing records and electronic files; completes, submits, and tracks initial and re-credentialing applications; verifies credentials; handles payer revalidation requests; and keeps provider and insurance information current. The position also supports credentialing staff training and work review, helps streamline provider and center onboarding and offboarding, and escalates personnel or enrollment issues to the appropriate leaders.

Requirements

At least 3 years of experience in provider enrollment and credentialing.
Extensive knowledge of provider enrollment regulations and guidelines, including Medicare, Medicaid, and commercial payer requirements.
Strong understanding of credentialing processes and best practices.
Experience with payer enrollment portals and systems.
Excellent communication, interpersonal, and organizational skills.
Ability to manage multiple projects simultaneously and meet deadlines.
Detail-oriented with a high degree of accuracy.
Strong analytical and problem-solving skills.
Proficiency in Microsoft Office Suite, including Word, Excel, and PowerPoint.

Nice To Haves

Bachelor's degree in healthcare administration, business administration, or a related field preferred.
Certified Provider Credentialing Specialist (CPCS) certification preferred.

Responsibilities

Compile and maintain current, accurate data for all providers.
Enter and maintain provider information in credentialing databases and systems, including Credential My Doc, CAQH, PECOS, NPPES, and SharePoint.
Perform primary source verification of state licenses, DEA credentials, and board certifications.
Complete initial and re-credentialing applications for providers and audit applications for accuracy and completeness.
Handle revalidation requests issued by payers.
Submit completed credentialing applications and supporting documentation to requested payers.
Monitor application progress and follow up with payers until in-network status is confirmed.
Maintain current copies of provider state licenses, DEA certificates, malpractice coverage, and other required credentialing documents, and track expirations to ensure timely renewals.
Track CME and send quarterly updates to providers.
Research and gather pertinent information about providers.
Keep billing insurance grids, provider insurance grids, and physician spreadsheets current with insurance changes.
Maintain practitioner electronic files and keep applications and licensures current.
Collect and validate documents to ensure credentialing elements are accurate.
Assist with training and monitoring credentialing specialists, assigning work, and reviewing work for accuracy.
Help streamline credentialing processes and provider and new-center onboarding and offboarding.
Escalate personnel issues to the Credentialing Supervisor.
Report or escalate provider enrollment issues to Revenue Cycle Management leadership.
Perform other duties as assigned.