ABA Director of Credentialing

Behavioral Health Works

9d•Remote

About The Position

Behavioral Health Works is an expanding company dedicated to responsible and sustainable growth. We are committed to delivering personalized ABA therapy for children and adolescents diagnosed with Autism Spectrum Disorder (ASD). ABA therapy helps individuals with Autism improve socially significant behavior, following the principles of Behavior Analysis. Our extensively trained BCBAs, Case Supervisors, and Technicians collaborate closely with parents to create tailored treatment plans that address the distinct requirements of each child. The Role Behavioral Health Works is seeking an experienced and strategic Director of Credentialing & Provider Enrollment to lead all credentialing, enrollment, contracting, compliance, and accreditation activities across our growing multi-state organization. This leadership role is responsible for overseeing provider credentialing operations across four affiliated companies operating in 10 states, ensuring compliance with federal, state, payer, and accreditation requirements. The Director will drive operational excellence through process standardization, policy development, team leadership, and continuous quality improvement while serving as a key partner to clinical, operational, compliance, and executive leadership teams.

Requirements

Bachelor's degree in Healthcare Administration, Business Administration, Public Health, or a related field; Master's degree preferred.
Experience within ABA, behavioral health, or healthcare services organizations.
Proficiency with credentialing and provider enrollment platforms, including CAQH, NPPES, CMS I&A, Availity, Salesforce, CentralReach, provider enrollment systems, content management systems (CMS), and Microsoft Office Suite (advanced Excel preferred).
Minimum of 7 years of experience in provider credentialing, healthcare compliance, provider enrollment, or payer contracting.
Demonstrated experience with multi-state provider credentialing and payer enrollment operations.
Strong knowledge of Medicaid, Medicare, commercial payer credentialing, and managed care requirements.

Responsibilities

Oversee end-to-end provider credentialing and recredentialing operations across four companies in 10 states.
Lead provider enrollment, revalidation, and maintenance activities with Medicaid, Managed Care Organizations (MCOs), Regional Centers, Medicare, and commercial payers.
Ensure provider records, licenses, certifications, and credentialing documentation remain current and compliant.
Develop and maintain credentialing performance metrics and service-level standards.
Ensure compliance with all applicable federal, state, regional, payer, and accreditation requirements.
Conduct internal compliance audits and implement corrective action plans when necessary.
Develop, implement, and maintain production and quality standards for the organization's compliance program.
Oversee ongoing monitoring of SAM, OIG exclusions, state license sanctions/exclusions, Open Payments, and Medicare/Medicaid Opt-Out status.
Serve as the subject matter expert for credentialing, enrollment, and provider compliance regulations.
Lead contracting and enrollment initiatives with Medicaid agencies, Managed Care Organizations, Regional Centers, and commercial payers.
Support payer negotiations, contract implementation, and provider network expansion efforts.
Build and maintain strong relationships with payers, regulatory agencies, and internal stakeholders.
Manage the end-to-end policy lifecycle and governance process.
Establish, implement, and maintain organizational SOPs, policies, and procedures.
Drive work standardization and process improvement initiatives across credentialing and compliance functions.
Lead accreditation activities, including preparation, implementation, and ongoing compliance with Autism Council on Quality (ACQ) standards.
Ensure audit readiness and regulatory preparedness across all credentialing and compliance operations.
Lead, mentor, and develop credentialing, enrollment, and compliance team members.
Establish departmental goals, performance expectations, and quality benchmarks.
Develop and deliver employee training programs related to credentialing, compliance, enrollment, and policy implementation.
Foster a culture of accountability, collaboration, and continuous improvement.

Benefits

Flexible remote work environment
Competitive salary and performance-based incentives
Comprehensive benefits package
Opportunities for professional development and career growth
Collaborative and supportive work culture
Leadership development opportunities
Health, Dental, Chiropractic, and Vision Insurance
Critical Illness, Voluntary Life, Accident, Hospital Confinement, and Basic Life Insurance
401(k)
Pet Insurance
Paid Time Off
9 Company-Paid Holidays per year, including 6 fixed holidays and 3 floating holidays
Professional Development Assistance
Employee Referral Program
Tuition Reduction Programs through affiliated university partners