ABA Director – Credentialing

🕒 Setembro 25

🇺🇸 Estados Unidos – Remoto (EUA)

💵 $90.000 - $110.000 / ano

⏰ Tempo Integral

🔴 Especialista

👔 Diretor

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Coyne & Associates Education Corp.

SiteLinkedInTodas as Vagas

51 - 200 funcionários

📚 Educação

🏥 Saúde

⚕️ Seguro de Saúde

Education • Healthcare • Healthcare Insurance

A Coyne & Associates Education Corp. é uma empresa especializada em oferecer programas de tratamento e educação baseados em ABA para crianças com autismo e transtornos relacionados, especificamente na faixa etária de 12 meses a 12 anos. Atende famílias em diversos condados, incluindo San Diego, Orange, Riverside e San Bernardino, com foco nas melhores práticas de terapia e educação para atrasos no desenvolvimento e na linguagem.

Descrição

• 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, 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 federal, state, regional, payer, and accreditation requirements. • Conduct internal compliance audits and implement corrective action plans. • Develop, implement, and maintain production and quality standards for the compliance program. • Oversee monitoring of SAM, OIG exclusions, state license sanctions/exclusions, Open Payments, and Medicare/Medicaid Opt-Out status. • Serve as 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. • Build and maintain relationships with payers, regulatory agencies, and internal stakeholders. • Manage policy lifecycle and governance processes. • Establish and maintain organizational SOPs, policies, and procedures. • Drive standardization and process improvement across credentialing and compliance functions. • Lead accreditation activities, including preparation, implementation, and ongoing compliance with ACQ standards. • Ensure audit readiness and regulatory preparedness. • Lead, mentor, and develop credentialing, enrollment, and compliance team members. • Establish departmental goals, performance expectations, and quality benchmarks. • Develop and deliver employee training programs. • Foster accountability, collaboration, and continuous improvement.

🎯 Requisitos

• 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.

🏖️ Benefícios

• 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