Credentialing Coordinator

Position Summary:
We are seeking a detail-oriented and organized Credentialing Coordinator to join our team in the field of Applied Behavior Analysis (ABA) therapy. This position is responsible for managing the credentialing process for all ABA professionals, ensuring compliance with regulatory and insurance requirements, and maintaining accurate documentation for therapists, technicians, and providers. The ideal candidate will have a strong understanding of healthcare credentialing processes, excellent communication skills, and the ability to work effectively with both clinical and administrative teams.

Key Responsibilities:

1. Credentialing Management:

Oversee the complete credentialing process for ABA providers, including BCBAs, RBTs, and other staff members.
Ensure all required documents (licenses, certifications, insurance, background checks, etc.) are submitted accurately and promptly to maintain compliance.
Maintain up-to-date records of all credentialing applications, status, and renewals.
Monitor and track deadlines for provider renewals and certifications to avoid lapses in credentials.

2. Compliance and Documentation:

Ensure compliance with all state and federal regulations, as well as payer-specific requirements (i.e., insurance companies, Medicaid, etc.).
Review and validate documents for accuracy and completeness.
Prepare and submit documents to insurance companies and other regulatory bodies as required for credentialing purposes.

3. Communication and Coordination:

Serve as the main point of contact between ABA professionals, insurance companies, and other stakeholders regarding credentialing status and requirements.
Liaise with clinical managers and HR to ensure timely credentialing and re-credentialing of staff.
Address any issues or discrepancies in the credentialing process promptly and efficiently.

4. Insurance Network Enrollment:

Coordinate and facilitate the enrollment of ABA providers into various insurance networks.
Submit necessary documents and follow up with insurance companies to ensure timely processing and acceptance.

5. Audit and Reporting:

Conduct regular internal audits of credentialing files to ensure compliance with company policies and industry regulations.
Prepare credentialing reports for management and insurance audits as needed.
Onboarding Support:

Assist in the onboarding process for new staff, ensuring that all credentialing requirements are met before they begin providing services.

6.Continuous Improvement:

Stay up-to-date with changes in credentialing requirements, industry standards, and best practices.
Recommend and implement improvements to the credentialing process to ensure efficiency and accuracy.
Qualifications:

High school diploma required;
Associate’s or Bachelor’s degree in Healthcare Administration, Business, or related field preferred.
Proven experience in credentialing or healthcare administration, ideally in the ABA or behavioral health field.
Knowledge of ABA therapy credentialing requirements and payer-specific guidelines.
Strong organizational skills with attention to detail and the ability to manage multiple tasks and deadlines.
Excellent communication skills, both verbal and written.
Ability to maintain confidentiality and handle sensitive information with professionalism and discretion.
Proficient in using credentialing management software and Microsoft Office Suite (Excel, Word, Outlook).
Experience working with insurance companies, Medicaid, and other third-party payers is a plus.

Benefits:
Competitive salary based on experience.
Paid time off (PTO) and holidays.

How to Apply:
Please submit your resume and a cover letter detailing your experience and qualifications to cristina_c@nesscares.com with the subject line: Credentialing Coordinator Application

We will start with the initial interviews first week of January.