Credentialing Specialist

@ Somewhere

About The Role

We are seeking a Credentialing Specialist to coordinate and perform a variety of operational duties required for provider credentialing and enrollment. This role will interact extensively with BCBAs, Care Coordinators, Health Plans, recruitment and clinical teams, and leadership. The ideal candidate will contribute meaningfully to the organization’s mission by facilitating provider enrollment and maximizing reimbursement for services rendered.

What You’ll Do

• Collaborate with BCBAs to maintain CAQH profiles for clean credentialing.
• Maintain BCBA documentation, including onboarding documents.
• Enroll providers with commercial and government payors; revalidate providers with health plans.
• Complete and submit enrollment applications to health plans.
• Audit payer directories to ensure accurate provider information.
• Handle payer calls to resolve contracting and credentialing issues.
• Ensure compliance with regulatory requirements from commercial health plans and state agencies.
• Prepare commercial, Medicaid, and third-party application forms.
• Manage reports and provider accounts for re-credentialing, re-validation, and expirables.
• Attend health plan trainings to keep internal teams updated.

About You

Eager to join a mission-driven organization with a focus on transforming ABA service delivery. A strong, clear communicator, detail-oriented and committed to high-quality work. You are a proactive problem-solver with a sense of urgency, curious and motivated to learn, and capable of handling multiple tasks with shifting priorities.

Requirements

• Minimum 3 years of relevant experience in ABA credentialing preferred.
• At least 1 year of experience working in ABA settings.
• Minimum 1 year of credentialing experience.

Key skills/competency

• credentialing
• provider enrollment
• compliance
• documentation
• audit
• BCBA
• CAQH
• health plans
• regulatory
• communication