ABA Credentialing Specialist

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Behavioral Health Works, Inc.

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

👥 B2C

💰 Corporate round on 2019-02

Healthcare • B2C

Behavioral Health Works, Inc. is a provider of Applied Behavior Analysis (ABA) and individualized outpatient services for individuals with autism and other developmental disabilities. The company works collaboratively with families, schools, payers and other professionals to teach new skills and reduce harmful or disruptive behaviors, and also offers ancillary support services and assistance with funding. Headquartered in Garden Grove, CA, BHW operates in multiple U. S. states and emphasizes a care-team and community-focused approach.

📋 Description

• Coordinate provider credentialing and re-credentialing for BCBAs and other clinical providers across multiple states. • Prepare, submit and track credentialing and enrollment applications with Medicaid, Medicare and commercial insurance payers. • Maintain provider records including licenses, certifications, malpractice insurance and credentialing documentation. • Monitor credentialing applications and proactively follow up with payers regarding application status. • Complete provider revalidations and re-credentialing renewals before required deadlines. • Maintain provider profiles within CAQH, NPPES, CMS I&A, Availity and other credentialing platforms. • Ensure provider files remain complete, accurate and compliant with federal, state and payer requirements. • Monitor provider licenses, certifications and credential expiration dates. • Perform routine audits of provider files and credentialing records. • Assist with monitoring OIG exclusions, SAM, state license sanctions and Medicare/Medicaid Opt-Out status. • Maintain organized electronic credentialing files and documentation. • Serve as a primary point of contact for providers regarding credentialing and enrollment questions. • Communicate with insurance companies, Medicaid agencies and commercial payers regarding application status and required documentation. • Assist providers with completing credentialing paperwork and obtaining required documents. • Resolve credentialing issues and enrollment discrepancies promptly. • Track credentialing and enrollment status using spreadsheets and internal systems. • Prepare reports on credentialing activities, enrollment status and upcoming renewals. • Identify opportunities to improve credentialing workflows and operational efficiency. • Assist with maintaining SOPs, policies and credentialing documentation. • Support accreditation and audit preparation as assigned.

🎯 Requirements

• Bachelor's degree in Healthcare Administration, Business Administration, Public Health or a related field preferred, or equivalent work experience. • Minimum of 2 years of provider credentialing or healthcare enrollment experience. • Experience with Medicaid, Medicare and commercial payer credentialing. • Experience using CAQH, NPPES, CMS I&A, Availity or similar credentialing platforms. • Strong understanding of provider credentialing and payer enrollment processes. • Excellent organizational skills and attention to detail. • Strong written and verbal communication skills. • Proficiency with Google Workspace (Drive, Sheets, Forms) and Microsoft Office, including Excel, monday.com.

🏖️ Benefits

• 100% Remote Work Environment • Competitive salary starting at $60,000 annually • Comprehensive benefits package • Opportunities for professional development and career growth • Collaborative and supportive work culture • Health, Dental, Chiropractic and Vision Insurance • Critical Illness, Voluntary Life, Accident, Hospital Confinement and Basic Life Insurance • 401(k) • Pet Insurance • Paid Time Off • 7 Company-Paid Holidays per year • Professional Development Assistance • Employee Referral Program • Tuition Reduction Programs through affiliated university partners