Credentialing Manager (ABA Healthcare)

• →Complete initial credentialing for BCBAs, psychologists, physicians, and other providers.
• →Manage provider recredentialing.
• →Submit provider demographic updates.
• →Process provider additions and terminations.
• →Maintain provider credentialing records.

Manage enrollments with Medicaid and commercial payers, including:

• Georgia Medicaid (GAMMIS)
• CareSource
• Amerigroup
• Anthem BCBS
• Aetna
• Cigna / Evernorth
• UnitedHealthcare / Optum
• Humana
• Molina
• Additional commercial insurance plans

• Contact insurance companies to resolve credentialing delays.
• Escalate unresolved enrollment issues.
• Follow up on pending applications.
• Resolve provider roster discrepancies.
• Investigate payer denials related to credentialing.
• Coordinate with payer representatives to ensure timely approvals.

• Review provider participation agreements.
• Negotiate reimbursement rates when appropriate.
• Negotiate contract terms with commercial payers.
• Track contract effective dates.
• Monitor contract renewal deadlines.
• Maintain executed payer agreements.

• Maintain CAQH profiles.
• Ensure provider documents remain current.
• Track expiring licenses, malpractice insurance, DEA (if applicable), and certifications.
• Maintain credentialing database.

• Maintain credentialing tracker.
• Report application status.
• Monitor turnaround times.
• Track payer approval timelines.
• Identify credentialing bottlenecks.

• Laptop with at least:
  • Intel Core i5 (or equivalent)
  • 8 GB RAM
  • Webcam
• Stable high-speed internet.
• Quiet workspace for daily phone calls.

• Minimum 5 years of U.S. healthcare credentialing experience
• Minimum 3 years of ABA credentialing experience
• Extensive experience credentialing:
  • BCBAs
  • Psychologists
  • Physicians
  • ABA clinics
• Experience credentialing with both Medicaid and commercial insurance companies.
• Experience managing provider enrollments from start to finish.
• Experience calling insurance companies to resolve credentialing issues.
• Experience following up on delayed applications.
• Experience maintaining CAQH.
• Excellent spoken and written English.
• Strong negotiation skills.
• Excellent organizational skills.

Experience credentialing with:

• Georgia Medicaid (GAMMIS)
• ABA organizations
• Multi-state provider groups
• Multi-location clinics

Experience using:

• CAQH
• Availity
• Provider portals
• Microsoft Excel
• Google Sheets
• Monday.com (preferred)

• Outstanding verbal communication.
• Strong phone etiquette.
• Ability to confidently communicate with payer representatives.
• Highly organized.
• Strong follow-up skills.
• Detail-oriented.
• Excellent time management.
• Problem-solving mindset.
• Ability to manage multiple credentialing projects simultaneously.