Credentialing Specialist at Sunrise ABA

Nashville, Tennessee, United States -

Full Time

Start Date

Immediate

Expiry Date

02 Jun, 26

Salary

0.0

Posted On

04 Mar, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Credentialing, Re-credentialing, Application Preparation, Record Maintenance, Renewal Management, Payer Requirements, State Regulations, Primary Source Verification, Database Maintenance, Compliance, Auditing, Risk Identification, CAQH, Medicaid, Medicare, Organizational Skills

Industry

Home Health Care Services

Description

The Credentialing Specialist is responsible for managing the credentialing and re-credentialing processes specifically for clinical staff at an ABA Therapy company. Responsibilities include preparing applications, maintaining accurate records, ensuring timely renewals, and complying with payer requirements and state regulations. Key Responsibilities: Complete and submit credentialing applications for new hires and existing clinical providers with various health plans and insurance networks. Maintain credentialing database, tracking application statuses, expiration dates, and required documentation. Proactively manage credential renewals, license expirations, and certification updates to prevent lapses. Conduct primary source verification of licenses, certifications, education, malpractice coverage, and other required credentialing documentation. Liaise with external agencies, insurance companies, and healthcare providers to resolve credentialing issues promptly. Assist in audits by providing credentialing information and documentation as requested. Identify potential credentialing or compliance risks and escalate appropriately. Ensure compliance with federal, state, and local credentialing regulations and internal policies. Regularly report credentialing statuses and updates to management. Occasional travel when necessary. Qualifications: High school diploma or equivalent required; Associate’s or Bachelor's degree preferred. Minimum of 2 years experience in healthcare credentialing, preferably within an ABA therapy or similar healthcare environment. Familiarity with CAQH, Medicaid, Medicare, and commercial insurance credentialing. Strong organizational skills with excellent attention to detail. Ability to prioritize tasks, meet deadlines, and manage multiple projects simultaneously. Proficiency with credentialing databases and Microsoft Office (Excel, Word, Outlook). Strong written and verbal communication skills. Ability to maintain confidentiality and handle sensitive information professionally. Preferred Experience: Previous experience specifically in ABA therapy credentialing or related healthcare services. Experience with electronic medical record systems or credentialing software.

Responsibilities

The Credentialing Specialist manages the credentialing and re-credentialing processes for clinical staff at an ABA Therapy company, which includes preparing applications and ensuring timely renewals according to payer and state requirements. Key duties involve submitting applications to health plans, maintaining the credentialing database, conducting primary source verification, and resolving credentialing issues with external agencies.