Certified Professional for Healthcare Accreditation

1 day ago

Mandaue City, Central Visayas, Philippines beBeeCredentialing Full time ₱7,200 - ₱7,800
Credentialing Specialist Job Summary

RemoteVA is seeking a detail-oriented and experienced Credentialing Specialist with a strong background in ABA therapy services. This role involves working with insurance companies to ensure clinicians have the necessary credentials to see clients.

  • Complete and maintain credentialing and re-credentialing applications for BCBAs, RBTs, and other ABA clinicians.
  • Submit applications to commercial and Medicaid payers, including CAQH, NPI, PECOS, and individual payer portals.
  • Track credentialing statuses, follow up on delays, and maintain regular communication with insurance companies.
Key Responsibilities:
  1. Maintain up-to-date records of licensure, certifications, background checks, liability insurance, and other compliance documentation.
  2. Coordinate start dates with HR and scheduling teams to ensure clinicians are active before seeing clients.
  3. Ensure accuracy and timely submission of demographic updates, reassignment of benefits, and provider termination notices.
  4. Monitor credentialing expiration dates and initiate renewals in advance.
  5. Assist billing team with credentialing-related claim denials and payer issues.
Requirements:
  • Credentialing experience, preferably in ABA or behavioral health.
  • Strong knowledge of credentialing processes and insurance requirements (Medicaid, private payers, CAQH, etc.).
  • Familiarity with BACB and state licensing requirements for ABA professionals.
  • Excellent organizational and time management skills.
  • Strong written and verbal communication skills.
  • Proficiency with EMR systems like CentralReach, Rethink, or Catalyst.
  • Ability to manage sensitive information with a high level of confidentiality and accuracy.
  • Knowledge of ABA-specific billing and compliance processes.

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