ABA Director – Credentialing

🔥 12 hours ago

🇺🇸 United States – Remote

💵 $90k - $110k / year

⏰ Full Time

🔴 Lead

👔 Director

👻 Ghost score 1%

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Coyne & Associates Education Corp.

WebsiteLinkedInAll Job Openings

51 - 200 employees

📚 Education

🏥 Healthcare

⚕️ Healthcare Insurance

Education • Healthcare • Healthcare Insurance

Coyne & Associates Education Corp. is a company that specializes in providing ABA-based treatment and education programs for children with autism and related disorders, specifically targeting ages from 12 months to 12 years. They serve families in various counties including San Diego, Orange, Riverside, and San Bernardino, emphasizing best practices in therapy and education for developmental delays and language delays.

📋 Description

• 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.

🎯 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.

🏖️ 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