Credentialing Maintenance Specialist

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Lighthouse Autism Center

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

⚕️ Healthcare Insurance

💰 Private Equity Round on 2021-07

Healthcare • Healthcare Insurance

Lighthouse Autism Center is a dedicated facility providing comprehensive therapy services for children with autism. With over a decade of experience, they offer a wide range of personalized, evidence-based therapeutic approaches such as ABA therapy, speech therapy, and school readiness programs. Their compassionate and clinically excellent team aims to unlock each child's unique strengths and potential in a nurturing environment, supporting families in the Midwest. Through innovative models like the Lighthouse Fusion approach, they make a significant difference in the developmental paths of children on the autism spectrum.

📋 Description

• Maintain accurate provider demographic information across internal systems, credentialing platforms, and payer portals • Coordinate provider maintenance requests, including name changes, address updates, supervising provider relationships, tax identification updates, and other demographic changes • Monitor provider licenses, certifications, DEA registrations when applicable, malpractice insurance, and other required credentials for timely renewals and compliance • Complete recurring CAQH profile reviews and attestations • Update provider information within payer portals and directories • Respond to payer inquiries regarding provider demographics, credentialing status, and appointment availability • Coordinate provider appointment availability updates and respond to network adequacy and directory validation requests • Maintain provider records within MedTrainer and other organizational systems • Partner with Credentialing Enrollment Specialists on provider maintenance changes requiring payer notification or enrollment updates • Collaborate with Clinical Operations, Human Resources, Compliance, and Revenue Cycle teams • Maintain organized documentation of provider maintenance activities, payer confirmations, and supporting records • Monitor regulatory and payer requirements and recommend process improvements • Assist with internal audits and compliance initiatives by keeping provider records complete, accurate, and audit ready

🎯 Requirements

• Exceptional organizational skills, strong attention to detail, and commitment to accuracy • Ability to manage multiple provider maintenance, recredentialing, revalidation, and compliance activities while meeting deadlines • Strong prioritization and time management skills • Knowledge of provider recredentialing, revalidation, licensure, certification, and payer participation requirements across multiple states and payer networks • Proficiency in Microsoft Office Suite, CAQH, payer portals, and credentialing/provider management systems • Experience maintaining provider records and monitoring credential expiration dates • Strong verbal and written communication skills • Ability to interpret and apply payer, regulatory, accreditation, and organizational requirements • Understanding of confidentiality requirements and ability to handle sensitive information discreetly • Ability to work independently and collaborate with Credentialing, Revenue Cycle, Compliance, Human Resources, and Clinical Operations teams • High school diploma or equivalent required • Minimum of two (2) years of experience in provider enrollment, credentialing, healthcare administration, or a related healthcare support role • Experience coordinating provider recredentialing, revalidation, licensure renewals, certifications, and payer maintenance activities preferred

🏖️ Benefits

• Fully remote work arrangement