Team Lead Credentialing and Payor Contracting

Behavioral Innovations•Addison, TX

2d•Hybrid

About The Position

The Team Lead of Credentialing and Payor Contracting ensures the timely, accurate, and fully compliant credentialing of all providers, including initial enrollment, re-enrollment, roster submission and linking providers to the appropriate locations across commercial, government, and contracted payors. This role leads the credentialing team, overseeing daily operations, workflow management, and performance metrics to ensure efficiency and quality. The position is responsible for facilitating provider enrollment and revalidation processes, maintaining complete and accurate provider records in credentialing databases, and ensuring all regulatory and payer-specific requirements are met. By ensuring accurate provider enrollment, this role directly supports revenue integrity, minimizes claim denials, and maximizes reimbursement for services rendered.

Requirements

Associate’s degree in healthcare administration, Health Information Management, Business Administration
Minimum of 3–5 years of experience in provider credentialing, enrollment, or payor contracting within a healthcare or behavioral health setting.
Experience managing full credentialing lifecycle (not just processing applications).
Prior experience in a lead or supervisory role preferred, with demonstrated ability to manage team workflows and performance.
Strong knowledge of credentialing processes, including initial enrollment, re-enrollment, revalidation, and provider-to-location linking across commercial and government payors.
In-depth understanding of payer requirements, regulatory standards and credentialing best practices.
Proficient in using credentialing softwares, payer portals, Electronic Medical Records (EMR), and billing systems.
Intermediate to advanced proficiency in Microsoft Office applications, particularly Excel.
Demonstrated ability to manage multiple priorities, meet deadlines, and work effectively in a demanding environment.
Ability to manage confidential and sensitive information with discretion and professionalism.
Self-motivated, highly organized, high level of attention to detail, and able to manage competing priorities.
Demonstrated commitment to continuous improvement, process optimization, and operational efficiency.
Strong analytical, problem-solving, and critical thinking skills with the ability to identify issues and implement solutions proactively.
Strong communicator who can work across teams and with external stakeholders.
Consistently embody and promote BI’s core values in all professional interactions.

Nice To Haves

Experience in multi-site healthcare or high-growth environments (ABA a plus)
Experience supporting DeNovo provider onboarding and managing credentialing timelines in a growth environment preferred.

Responsibilities

Facilitate payor calls to resolve contracting and credentialing issues.
Support DeNovo site launches by ensuring new providers and locations are credentialed, enrolled, and billing-ready on time.
Coordinate provider onboarding, including payor enrollment and provider-to-location linking across all applicable networks.
Proactively identify and resolve enrollment obstacles to prevent delays in credentialing and reimbursement.
Partner cross-functionally with HR, Revenue Cycle, Billing, and Clinical teams to ensure alignment and operational readiness.
Serve as a key point of contact for external payors to maintain compliance, clarify requirements, and expedite enrollment processes.
Monitor credentialing progress to minimize disruptions to billing and ensure continuity of care and revenue flow.
Ensure adherence to all payer-specific and regulatory requirements throughout the credentialing and enrollment process.
Drive collaboration across internal and external stakeholders to maintain efficient, accurate, and scalable credentialing operations.
Maintain a strong focus on accuracy, timeliness, and process consistency to support provider satisfaction and financial performance.
Maintain confidentiality of all information in accordance with HIPAA and organizational guidelines.
Utilize multiple methods to verify enrollment status, instructions, and application processes (outbound calls, web portals, email).
Communicate with the revenue cycle team to ensure provider numbers and enrollment dates are accurately entered for claim submissions.
Coordinate enrollment for providers into out-of-state Medicaid programs as required.
Prepare commercial, Medicaid, and third-party application forms for credentialing and re-credentialing, manage existing provider accounts, and manage expirable items.
Respond to all client or center inquiries within 24 hours of receipt.
Demonstrate proficiency with Electronic Medical Records (EMR), billing systems, and Microsoft Word/Excel.
Promote BI’s cultural values: Caring, Accountable, Collaborative, and Family-Focused.
Exercise strong analytical, problem-solving, and organizational skills while maintaining professionalism in all communications.

Benefits

Comprehensive Benefits: Medical, Dental, Vision, and Supplemental Insurance.
Work-life Balance: 15 days PTO, plus 7 Paid Holidays
Wellbeing & EAP Programs: Supporting your personal and professional wellness.
Career Growth: Be part of an expanding organization that will double in size within 18 months, opening doors for professional advancement and leadership opportunities.
Family-Centric Culture: Recognized for clinical excellence, integrity, and innovation
Mission-Driven Work: Transform the lives of children with autism while building a stronger future for yourself and your team.
Recognized Industry Leader: Named Company of the Year in 2022, reflecting our continued growth and impact in the ABA field.
National Recognition: Proudly ranked on the Inc. 5000 list as one of America’s Fastest Growing Private Companies - for 3 consecutive years!

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