Healthcare Credentialing Specialist

Job title: Healthcare Credentialing Specialist

Type of employment: Part-time

Shift Schedule: 10:00 AM - 2:00 PM EST

High-level summary

Support the operational readiness and growth of an ABA program by managing U.S. healthcare credentialing, provider enrollment, compliance documentation, referral outreach, and administrative tracking.

This role combines healthcare administration, credentialing, compliance, and referral coordination, requiring someone who can manage detailed processes while proactively following up with payers, providers, and referral sources.

The ideal candidate is highly organized, persistent with follow-ups, comfortable navigating payer systems, and able to manage multiple administrative workflows independently.

About the Company:

The company provides healthcare-related services supporting ABA programs and requires accurate provider documentation, organized operational processes, and reliable administrative support.

The organization relies on structured credentialing, enrollment, compliance, and referral processes to support the successful delivery and growth of ABA services.

This role will help maintain the administrative infrastructure required to keep providers credentialed, requirements tracked, and referral relationships organized.

Company core values:

• Accuracy and compliance — committed to maintaining complete, accurate, and up-to-date provider and program documentation.
• Confidentiality — protects sensitive healthcare, provider, and organizational information with professionalism and discretion.
• Accountability — takes ownership of applications, deadlines, follow-ups, and outstanding requirements.
• Organization and consistency — values structured processes, accurate tracking, and reliable execution.
• Proactive collaboration — communicates regularly with internal staff, providers, payers, and referral sources to keep processes moving.

Objective of this role:

• Manage credentialing, provider enrollment, and recredentialing activities for ABA providers.
• Support ABA program setup and ongoing compliance by organizing requirements, documentation, and approvals.
• Build and maintain relationships with service coordinators, case managers, and other referral sources.
• Maintain accurate trackers, documentation, deadlines, and status reports across credentialing, compliance, outreach, and administrative activities.
• Ensure outstanding requirements and follow-ups are consistently monitored through completion.

Responsibilities:

ABA Credentialing & Provider Enrollment

• Manage credentialing, enrollment, and recredentialing processes for ABA providers.
• Prepare and maintain provider documentation and application materials.
• Submit and track applications through Medicaid, payer, and credentialing systems.
• Follow up consistently with Medicaid, payers, and credentialing entities until applications are completed.
• Monitor credentialing deadlines, renewal dates, outstanding requirements, and application status.
• Maintain accurate credentialing trackers and documentation.

ABA Program Setup & Compliance Support

• Research and organize requirements necessary to launch and maintain ABA services.
• Create checklists and workflows for program setup and compliance requirements.
• Track outstanding documentation, approvals, and operational requirements.
• Maintain organized compliance records and supporting documentation.
• Assist in developing SOPs for recurring credentialing, compliance, and administrative processes.

Referral & Coordinator Outreach

• Build and maintain referral/contact lists for potential ABA referral sources.
• Identify and engage service coordinators, case managers, and other relevant referral partners.
• Conduct outreach through email and phone to introduce the ABA program and establish relationships.
• Send consistent follow-up communications and track outreach activity.
• Maintain accurate records of contacts, conversations, referrals, and next steps.

Administrative Follow-Up & Tracking

• Maintain credentialing, enrollment, compliance, and outreach trackers.
• Monitor deadlines and proactively follow up on outstanding tasks.
• Organize digital files, provider documentation, and program records.
• Schedule follow-ups and maintain clear task lists.
• Prepare regular status reports covering credentialing progress, referrals, outstanding requirements, and other key activities.
• Identify potential delays or missing information and escalate issues when necessary.

Required skills and qualifications:

• Direct experience with U.S. healthcare credentialing and provider enrollment.
• Experience with ABA, behavioral health, healthcare operations, or related healthcare administration.
• Familiarity with Medicaid provider enrollment and commercial payer credentialing processes.
• Strong understanding of provider documentation and credentialing workflows.
• Knowledge and experience in using AI
• Strong written and verbal English communication skills.
• Excellent organization, time management, and follow-up skills.
• Ability to manage multiple applications, deadlines, documentation requirements, and outreach activities simultaneously.
• Strong attention to detail and accuracy.
• Ability to work independently and consistently follow through on outstanding requirements.
• Experience with CAQH, NPPES/NPI, Medicaid provider enrollment systems, and payer portals.
• Proficiency with Google Workspace, Microsoft Excel, and CRM/outreach tracking tools.
• Industry experience is required.

Preferred skills and qualifications:

• Direct experience with ABA provider credentialing and operations.
• Experience with D.C. Medicaid, ePREP, or MPRIME.
• Experience working with Carelon or behavioral health payer portals.
• Experience building referral relationships with service coordinators, case managers, healthcare providers, or community organizations.
• Experience creating SOPs, checklists, trackers, and operational workflows.
• Previous experience supporting the launch or expansion of an ABA or behavioral health program.
• Experience managing credentialing and referral operations in a remote or fast-paced healthcare environment.