Credentialing Specialist

2 weeks ago

Pasig, Philippines RemoteVA Full time

Position: Credentialing Specialist Industry: Applied Behavior Analysis (ABA) Employment Type: Full-Time Gender: Open to all candidates Location: Remote / On-site (specify based on your setup) Overview We are looking for a highly skilled and detail-oriented Credentialing Specialist to join our team. The ideal candidate has exceptional organizational abilities, strong communication skills, and proven experience managing credentialing processes in healthcare or ABA settings. This role is critical in ensuring our clinicians maintain accurate, up-to-date credentials and compliance with payer, licensing, and regulatory requirements. Key Responsibilities Manage the full credentialing and re-credentialing process for ABA providers with insurance companies, licensing boards, and regulatory agencies. Prepare, complete, and submit credentialing applications and documentation accurately and on time. Track provider credentialing status, expirations, renewals, and compliance requirements using internal systems. Maintain organized and up-to-date digital records of all provider credentials and documents. Communicate professionally with clinicians, insurance representatives, and internal departments regarding application status or missing requirements. Resolve credentialing issues or delays efficiently to ensure uninterrupted billing and service delivery.Verify provider qualifications, education, background checks, and certifications. Ensure compliance with state regulations, HIPAA, and payer-specific standards. Work cross-functionally with HR, Billing, and Clinical teams as needed. Assist in system improvements, workflow development, and process documentation for credentialing operations. Requirements Experience in credentialing, healthcare administration, or ABA operations strongly preferred. Strong understanding of credentialing requirements, insurance payers, and regulatory standards. Exceptional written and verbal communication skills — must communicate clearly, professionally, and effectively. Excellent organizational skills with strong attention to detail and accuracy. Ability to manage multiple deadlines and tasks in a fast-paced environment. Proficient in credentialing software, Google Workspace, Microsoft Office, and document management platforms. Strong problem-solving abilities with a proactive, self-driven work ethic. Ability to collaborate with cross-functional teams and maintain positive working relationships. #J-18808-Ljbffr

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